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` FOR OFF USE: ln.�/�.'3 ) C /C '3 Permit No. .:� ... .. / -"""----_- -" - _-- ___----__- ---r� APPLICATION FOR SANITATION PERMIT :. in?.Du licate �. -------- (Complete P Date Issue`--✓--_ll ��`' --____-------------__--"_--- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- ' ------------- - Q T--------------------------------------_.-----------------__----------------------------- Owner's Name �.Q 0=t_.,�-_f�-_N-a R— ------ PhoneJj a_•,?-_e.7.A...8 Address-----------_-- ---5-a-!N!•f•) Contractor's Name -D = �� = -M = - ..................... Phone..i _Q...G. _ an-7. Installation will serve: Residence [vY Apartment House ❑ Commercial ❑ Trailer C6urt [] Motel ❑ Other ❑ Number of living units: ___1___ Number of bedrooms _ -_. Number of baths ____!__ Lot size ______57C..........+A-...... ................. Water Supply: Public system Rr Community system ❑ Private ❑ Depth To Water Table ________ ft. it Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [)"'Adobe Q' Hardpan ❑ Previous Application Made: (It yes,date--------------------) No [21 New Construction: Yes ❑ "No [ja,' FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation....................Material-----------------------------------.............. @( x No. of compartments--------------------------Size----------------------------=--•Liquid depth--------------------------Capacity-.._---------------- Disposal Field: Distance from nearest well__il)-f?__L Distance from foundation...-_I".O-'......Distance to nearest lot line-_-_°ST_+_. [vj rx tSil� Number of lines-------------I--------------------Length of each line--------- of trench------------2.'��F__j________ � - ... !q P D Type of filter material--.TQ Q_t.<_-__-__Depth of filter material______1-. .'______Total length_____________________ ' Seepage Pit: . 106Distance to nearest well__-1�}-Ct_N._ .--Distance from foundation-----/Q.........Distance.to nearest lot line----_S___...... p Number of pits------I______-______Lining material__ -----Size': Diameter_-_:=,�s--_-_____.Depth-- -- _'_...____.. Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material___-_-___.---------.............._._ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. + Privy: Distance from nearest well____________________________________ g--_--.--._----------- ____________Distance from nearest building __________________. ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------------••----•- ----------- ' Remodeling and/or repairing (describe):--------jGrlA--------__1-_Q--------C-X---S__- •--1-I`-_�_____________.._SC' ._!_ _111k.1-------------------------------- -------•----------------------------- ----- -------------------------------•-- --------------- ---- ------------••-------------------------------"--------------------------------•-----------•----- --------------------------% I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..------ .......... 't'- - --------- ----------` ,max}, - -----------------------------------------(Owner and/or Contractor) By:............ ►.�- i A.cv� R -++- ` .-------------------------------------`----- --------- •---------(Title)-•------ --&-.-----"---------- ....... --------- (Piot plan, showing size of,lot, location of system to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPA TMENT USE ONLY. / \ APPLICATION ACCEPTED BY-"-"-- �� - DATE--r - -- - --[�-`. --------------------- ------------------ REVIEWED BY. - --•----- -------- ----- DATE - f BUILDING PERMIT ISSUED............. - ---------------------- D TE.. Alterations and/or recommendations:..___d�_ p_ ----------------------------- - ------------------------•-•--------`---------------="-•-"-----•----------.--------------•-----•--------------- - ---- ------------------------- ------------ ------------------•---•---- -----------------•---•----------------------------------------- -- ---- � ----•- FINAL fNSPECTlO BY Y/2), -•--- - --------- -------- -- ----`� Dater------- {.� --- SAN JOA IN LOCAL EALTH DISTRICT 130 South American Street 300 West Oa Street 124 Sycamore Street 205 Wool 9th Street F ` Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS _ _