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FUKV- -(EU En --- -- --�•�: - �� APPLICATION. FOR SANITATION PERMIT Permit No. .:�7 `T` -------------------- ---------- --- ---- Y (Complete in Duplicate) _ .. _ _.. —Date ., _.. Issued .: - --- --------------- Tfiis'Pe`rrnit Expires lE Year From DateIssued.,.r Applicaf ion,is hereby,enade to'Fthe 1.San Joaquin Local'Health.District for a permit to construct and install the work herein described. This application is made incompliance with County.Ordinance N . 549. JOB ADDRESS ANLOCATI �� t - -' ----- ••. ... .... ----------•-----------•--- ----- Owner's Name. ---- . •= i-L ...:. •_ ---------... • -- --•--- Phone.......--•--- `-------- •-• i ---- 1 T ' f �l Address = r ---------------------------------------------------------------- f.. Contractors Name_---------- �� - --- --•-- ---- -------------=-----------------------------------------_----- ------ Phon Installation will serve: S.Residerirce-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0`1 Number of living units:.,_ Number of bedrooms Number of baths../_ Lot size _1400--� _Q_CJ S�__._.---._._ l r � L Water Supply: Public tsysteml®'mmuiiity system ❑'"FRvate❑ ;Depth to Water Table!ilft. + Character of soil to a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ , Clay Loam ❑ Clay ❑ Adobe Er-�Iardpan ❑ Previous Application Made: (If.yes,date-_-------------' No Ea-- New Construction: Yes'E] No B-`FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { o septic tank'or cesspool permitted if public sewer is available'within 200 feet.) �+ No. of co 'ti p from nearest well-----__-----=-----Distance from foundation....................Material-----------------------------.:.:.-----•---.-_-•. tic ank:E, Distance M 4 . f � o le 8: Distance �partments---• ---------Size-------------------F------------Liquid depth--------------------------#Capacity-:=--.•'-•-�-�-- Numbeprom nearest e�---Distance from foundation_/6--------.Distance to .nearest lot line..?......... 1 lines.-_...-- __ Length of each line--------------/_S._--..Width of tench------c - -- ---------- Seepage Pit:; yi a of to material- �- - Depth of filter material_- .-_ _ Total len fh......................Z-__...__..-- T eoffil - `� I o nearest ell_ ..-_Distan fo nclation...../,0.. _.Distance to nearest lot line---:-_-1...-__ \ Nu Ger of pits_______ ___________Lining material. Size:.•Diameter_ 3-.��.._.Depth__.,2_r��._... ......... ' / Cesspool: Distanccee _ from nearest well-----------------Distance from foundation---------.--...._ .Lining material...........................:......... ❑ Size: Q El i Teter------•-------------------------------Depth----------------------------------------------------Liquid Capacity---------••---------..... -gals. I Privy: Distance from nearest well------------------------------------ -.----Distance from nearest building----------------------------------------- Distance t --- ❑ o nearest lot line-------------------------------------------------------------•-----••- --••-----..._---------------------------------------------=--------- }. Remodeling and/or repairing I�(describe)=--------------------------------------------------------------------------------------------------------------------------------.....---....-- --.------ I 11 s --•--•-------------------------------------------------------- --------------------- -•--------------------------------------------------------------------------------------...-------------------------------- - P i I, i ---------------------------------------•------•--•----...---------•--------------------------------------------------------------------------- -------------.......----...------------------------------------- i li - ! hereby);certify that---8 -------••-----------------------------•-------•---------------....-----....-----------------------...----..-..-------------...-----------.....---------------------...._.. v prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State,laws, ru s and relu tions of the San Joaquin Local Health District. . 1 (Signed).. II ... ... . -------------- ----- --------------- --- --------------------- - wner and/or Contractor) ' B �,'------------ ----- - ------. --------(Ttle)-------- ---------------------•------------- -- (Plot plan, showing size of lat,,location of sy em in relation to wells, ildings, etc., can be placed on reverse side). ,f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.(..- .-___--_ - - __ _ ------------------------------ DATE_.-3---`- 2 7 --- CO-z'----------- REVIEWEDBY----------------------------------------••--- ----------------------------------------------------------- .......... DATE-------- BUILDING PERMIT ISSUED--.-!'---------------- ------••---------------- -- - DATE Alterations acid/or recommend'ations-------------.---------- - --------- -....--•,•-•- 3Q - ------------ = R.. �.� -------------------------------------------------- ----------------------------------------------------------------------------------------------- ------_----- ----•---------------------•------------ . IN --------------------------------------------------------------••----------------------------------------------- ----------------------------------------- --------'i-------------- ------------------....-...----•-----------.•------.._.._.......----------------......--.--•-----•-------•--------...-------------------------------_---. FINAL INSPECTION BY:.... .+ Date----- .` �Q --------------------------- ---•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Colifornla Lodir California Manleear California Traeyr California ES 9 REVISED 5-59 PM 3.61 ATLAS I I�