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--------------------------------------- ---------- �. r .. Q �'�f --------- APPLICATION FOR SANITATION PERMIT Permit No. ... .417 --------------------------------------------------------- (Complete in Duplicate) �7 / This Permit Ex:tires 1 Year From Date Issued Date Issued ....__ 1,6 -c., Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her 'n described. This application is made in compliance with County Ordinance No. 549. � `TEC JOB ADDRE;S�S F AND LOCATION•_--_- C�cg_---•--5 Owner's Name._10' kRx�- Q _ 1 � _,� •- in�Parr-•------------• -- ------- --- Phone..... Address_----/:5p./ ---- ---------J l�_ L ----..ST----------------------------------------------------------------- Contractor's Name------ - �Q�----- � � %% ----------•---•----•-----------------------------•----- - -----•-----•--•-•-- Phone.. Installation will serve: Residence �'��" Z- I Apartment House ❑ Commercial ❑ 4Trailer Court E] Motel ❑ Other ❑ Number of living units: _�----- Number of bedrooms -_�j-- Number,.of.baths �7_ Lof-size � .... Water Supply: Public system ❑ Community system ❑ Private VDepth ro Water Table _ .._ ft. k Character of soil to a depth of 3 feet: Sand Gravel Sand Loam 1 ❑ Y Q� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan (] Previous Application Made: (If yes,date.__--_.__ --------.1 No Lai New Construction: Yes ` TYPETOFYINSTAtLATION-'4AND-SPECIFICA-TIONS: _ ANO El ,— .-- : Yes [I No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well---__-------DistarlCe from foundation__-_,Q1•_------.Materiah.- �/�[/[�Q� r, . No. of compartments Size '. 4 �".."- ~ ��. '-�-.� _ _�X-� �_ Liquid depth_ ---f-Capacity.... E Disposal Field: Distance from nearest well_._._- --_Distance from foundation____. I ' ��Q Number of lines_.._______,j- 1p--_---.Distance,fo.nearest lot line__ ..t -.._.____.-,__Len thlof each line____-__ +� ' 1 q i� �. g --•---- ----.Width 0.titrench-------�Z. Type of filter material._._ OG. - t� ---------- �'f1Depth of filter material___--___1S_._____Tota! leIgth.________-._,1. ©_ Seepage Pit: Distance to nearest well-_____________________Distance from foundation---------.._.______ c� -Distance.fo nearest lot line_________________ Number of pits------------------- Lining material----------------------- Size: Diameter --- - Depth----•--- ----------------------- Cesspool: N i' Distance from nearest well_.__.___�_.__.Distance from foundation___-----------------Linin maferial__.__-__________________--__ F Size: Diameter --------:._Depth-------------------- -----------------------------Li Liquid da aci Priv'`: '� q j p tY ------------------gals. j ❑Y Distance from nearest well____________________ -------------Distance from nearest buildin Distance to nearest lot line g --•-----•--- . ri Remodeling and/or repairing (describe):------------------ ---------------------•-----•------••----••---•---- ----• •- -------------------••------•------•-------•-----•-•--••--•---------•----•----•--------------- � -- -- ---•-----••-------------•------------------- ----•----------- -------- •----•---•-•-- I •--••- hereby certify that I have prepared fhi�application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regullafbns of he San Joaquin Local Health District.° • (Signed). �! Y� } =T ---- (Owner and/or Contractor) Y--------------------------- ------- s - ..� _ 1 BY� t l;--------- ------------------------(Title)-------------------------------- (Plot plan, showing size of lot, location of systami;in relation to wells;rbuildings, etc., can be:placed on reverse side). � u h FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._. r '-�- ---------- ----- ------ -- DATE-----7 ---� REVIEWED BY------------------------------------ ---- - -�- - --------•--------••------- ---- ------------------------------ DATE-.-----•-•---•--•---•------- BUILDING PERMIT ISSUED -�------•----�----- erations and/or recommencrations:_______-_--_ ----., DATE. -----•----- --• ---------•------------------••.---------•----- � ' N�' 13- 3cls{.---A5---- >AAT-__CSF--- ------ --- --------- ----- ------------------------------I------------------------------- ------------------------------------------------------------------------------------ -••----------------- ---•-• •--------- -------- ,• ---- Ie �r---, - - --- •------------------------••- FINAL INSPEC ON BYZ _ .: ---�- -"l 4,t 4Date-- ' �= �,�-`.fi�.�-�" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street "^ 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California -.. Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS �"`