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- ► ------------ --- -- ------------ ------ ---- --------------- -------------------"--._._ APPLICATION FC)R SANITATION PERMIT Permit No. ......1_.r ,- --------•---------- ------- (Complete in Duplicate] F .j,r e v ---------------------------------------------------- --- f q so-Y This permit Expires 1 Year From Date Issued , Date Issued .....-_-1...- .Application is hereby made to the Sen Joaquin Local Health Districi•-for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. I J08 ADDRESS AND,LOCATION. �- ---._-�- I , . _ 1-- � .. . Owner's Na �,-.I'11 . _ ----•----......... --• ---- --------------------------------------------- Address-----•" p � — •--------------- Phone�!1-----�.."-.�1J.'�.'Z.�. k.... ------3'7-/------- /� T -------- --•-- - ............ Contractor's No Me____ A-------------------- men ._.. ------------------------------------------ Phone ? I�Installation will serve: Residence t Apartt House ❑ Commercial ❑ Trailer Court � � l ❑ Motel ❑ Other ❑ Number of living units: "-_.- Number of bedrooms Number of baths C--- Lot size Water Supply: Public system V Community system ❑ Private ❑ ` Depth to Water Table ..-%/ft. -•-----................. -•-- Character cf`soil-to'-a depfh 60-ftef:�fiend - �Glavel`❑=5bndy Loam-[Clay Laam`❑ Clay y-❑`Adabe-❑• Hardpan •_�-_ (Previous Application Made: [If yes,date---------- No ❑ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND 5PECIFICATIONS: � (No septic tank or cesspool permitted if public sewer is availablefwithin 200 feet. SA tic T p Distance from nearest well__} .y Distance from E 'foundation undafiion .Material----•-----•-No. of compartments.---- �_---------Size-3X' -tX `-l 7Y11 ? 71) ..Liquid depth----01-- -----------Capaci faC� Disposal Field: Distance from nearest well Teva €R._Distance from foundation--.. _ � .......Distance to nearest lot lie `.. _ Q� Number of lines...!....../-•- --_--- �-�" N .---__--Length of each line..-_. -Q Width of trench---------3�..- " Type of filter material._ CTC "-- .i -----Qepfih of filter material----� ------------Total length----.__---__••-� ' .Seepage Pit: # .. Distance topneare�t#ell--_----------------Distance from foundation_-� "'1----.Distance to nearest !ot Eine--.._-_...-__...- ❑ Number of its----------------------Lining material---------- .Size: Diameter__"_••----• ---- Depth................................. ----------------- Cesspool: Distance from nearest well--.-_..__--._-._-Distance from founda% n------__--.---1_-. -�- _ Lining material------------------ ••---•----•------- Size: Diameter- f----------- ---------------Depth.---------------- �------------------------ F- Liquid Capacity------------------- P`riv gals. Y Distance from nearest well------------------------- ------------------ ------Distance from nearest building Distance to nearest lot line- _ _ .. 9 ! ---------•------------- ------------------- Remodeling and/or repairing (describe)-------------------_----- ? EM ---- ------------- -•----•----"--------------i-•-------- �l _.._-_.•___________________________________ _ I - ------------------- I�di11lereby c �ify that I have pre aced this application and that the work will be done in accordance with San Joaquin County nances. St +e laws, and r les r gulations of the San Joaquin Local Health District. (Si read ✓ -------•---------•----------------------------------------- -----(Owner and/or Contr�actor) By:-------------------- - - -- - -- -- Title (Plot plan. showing size of lot, location of system;.ni relation to wells, buildings, etc., can be placed on reverse sidel. r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y_----- = DATE----- y-- REVIEWED BY--------------•--•------Po-'�-��--ro�-------#------•"--•------ .. BUILDING PERMIT ISSUED.-----.1Q+r[. .. �-. •------------------ DATE--------- K�--.-,CF,�K . ' __Q�-K -- D/�TE.--. --•----------------------------------•----- All�erations d/or recommendations:.--- -•---------•�---�----------------------------------------- ----------- -------------•----------•-- -------••--------...-------- ..-•-----...--------...-----...-..---••------•-------•-----... .-ll--_G- --- ,, /9!� ./ ,�O�l /1(Q----- WS. �C'r1Q1�1...--Cf}�(- - ,FD EI •-- [l/lA. f3F Sc# '.." omit-----"S_._1At -PE�'> >rL� _> o y --••-•-••--.......i -d- ------p---r TR_�4-- - R= °�. - .._ ....... --------------------- - ---- -------------- -------•----- FINAL INSPECT! --- - -- - Date...... ....... •- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 91h Street _ Stockton,California I Lodi,California ! Manteca,California Tracy,California EB 9 REVISED B•89 2M 8-61 ATLAS •