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__IFOR OFFICE USE:-------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. /-�.2..�7-_. . --- ------------------------ ------------ --------------- (Complete in Duplicate) I / Date Issued --------------------------- -------- -------------------- 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 com li rete with County Ordinance No. 549. A119N-rr=— �.,B0• ; JOB ADDRESS AND L CATIO .--S4_V'n-{-__ _ 1!i�-___ __�,___��Vt__•___�- Owners Name............. - r L + L------•----_--- •-----------------------------------------------------Phone............................... Address............X'tW_-`1--=":_. -0.54--------Zf-!'� Contractor's Name___ - .................•-•............._....... PI_i'one.............................. Installation will serve: Residence Apartment House [D/, Commercial E] Trailer Court [-] Motel,❑ Other Number of living units: Number ❑ hof bedrooms :Number of baths -I__ Lot size .... ..._...��:�:R. ......._. ._- -. Water Supply: Public system [3CommuniF s s em ❑_Private De th To Water Table / - ft. Character of soil to a dep+h of 3 feet:- Sand Gravel ❑ Sandy Loam^ CIayy Lo ❑ Clay ❑ Adobe E] Hardpan Previous Application Made: (if yes,date_.'_..�.__-.-.-.-} Yes �/I�❑ ,�� [ (i`l t Yd' New Construction Yes o FHA/VA:.Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ° - * r ' 1 fee( Septic +asP lP s#efpuavailable 200 .}A Septic TankDistance from nearest Distanefrom foundation------•--_`-- ------.Material-------------------------------------------- aterial--------------------------------------------4 ................ E; G— No. of compa}rtmentsi- _' ~- - E Liquid depth_-k-_ ---------------Capacity.... Disposal Field: Distance from nearest ell---�.--- Distance from foundation----- 0---------Distance { g?` to nearest lot line_-_ Yr<� Number of fines---------- ----- 9 1 ----_-_-__-..---iLength of each line--------,� _ -----.Width of trench---..-- F�•----------� I Type offilter material`: t ..,, .Depth,of,filter,material_ __Z_/.'i`.__-:._Total length___------,�,�...................J t Seepage Pit: Distance to,nearest-well_-�,--- -------Distance from foundatidn--------------------Distance to nearest lot line----_-_.---_- ❑ Number of..pits--------------•-.r_---Lining material_....--_...-- ------Size:,Diameter------------ _......Depth----••-----------___......-_-: ` h -.1.11111 Cesspool: Distance from nea�estIwall__--------------_Distance from foundation--------------------Lining material...-...-----_-------.__-----_--._r ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals tj Privy: Distance from nearest-ell-------------------------------------------------Distance from nearest building-------------------------_-_----_--------. t ❑ Distance to nearest lot line.-.------.-- ________________________"_-_ Remodeling and/or repairing (dessccrill,---f�-- "- 3--------------s_67_-9W--------/ `-Ali-4-CA......!__i Tk4tZ&X�--------- egR,011.77-- -------A-11 s.r"�-�.fi��14:�. 4_5---•-----1-1•hes.�s!_Al:---�------------------------------------•------------------...................:------------------ -----------------------------------------•---•---••--------• ----- ------------�•_F-�..0,t------_------------------•--- -------------------------------- --------------•-------------•--- hereby certify that I have prearedfhis application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and ru and'regtilatio of the San Joaquin Local Health District. t (Signed)------- ---------------T_` -------(Owner end/or Contractor I 4 By: .... .. (tria) (Plot plan, showing size of lot, location of`ystem1n. relation ion to wells, buildings, etc., can be,placed on reverse side): FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---------- -----I -K`-0_-------------------------_- -- 4 --------------------------- DATE-.1.":=- ----�-=��--�-------��------------------------------- REVIEWED BY -----------------••---------------------------------------------••----------------- ------------------------ ---------------------- DATE-"o BUILDING PERMIT-ISSUED----= ------- "------------------------- Altera itoWard/o --' = `Alterattnand/oecommendations:-_.--------------------------------- I _________-_ , ••------------------------------..........--------------------------------------------- ---•------------••------•-.--._ .._.. ---- ---------- ---•-----` _ ----•---- - r ---------------------------------------------------------------..-------------------------------- ------------------------- - -•------------------•----------------------•--------- FINAL INSP ON BY:-- �L��L ._ -. ...- � Date------------ ' f -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California '' Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS �` a