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FOR OFFICE USE: ------------------ -------------------------------------- ! ! a7 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---..... ......._.--- --------------------------------------------------------- (Complete in Duplicate). --- This Permit Ex fres 1 Year From Date Issued Date Issued --9_.---•--1_Sa-� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he in described. This application is madt3 iri compliance with County Ordinance No. S49. E5 0 VVr: ' JOB ADDRESS AND ?.1,3 -.-. - A- Owner}s Name- Q_/77,frLt.�!/� ._ Cs4• 0. � X1 PhoneJ)!�G?.ES�1P .. Address......-------�'��. -- ----•---•----•-•----.....---•-------------------------------------••---------------------------••----•-----.. Contractor's Name. ---roow...- ----------•--•-••--------------------•-------....... Phonewoo�OAy4697....... Installation will serve: Residence �I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'Number of living.units: 4__- Number of bedrooms _T-- Number of baths ..An Lot size . --_--- ''........................ Water Supply: Public system ❑ Community system ❑ Private J121 "Depth-to Water Table -------- ft. Character of soil to a depth of 3 feel;: Sand ❑ Gravel ❑ Sandy Loam e6lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------} No Fr New Construction: Yes ❑ No v❑' FHA/VA: Yes ❑ No ❑ - TYPE OF INSTALLATIONTA—N 'SPWIFICATICNS: or cess ool ermitte ' `ublic sewer is available within 200 feet, r I ~' [No septic tank �_.,--P..�__•. ,dif.P - =.ter..... ).. y Q Septic:Tank: Distance.from nearest well-�w.---0 _stance fr9r undation__-moo___-------.Material------ 1A........ [� No#of compartments----------Zr--_-.-.----Size-_ , Liquid depiIh.f-. ..-_-- parity... .?.. Disposal Field: Distance from nearest well---/Q�+!- Distance from foundation.---�7-........Distance to nearest lot line:_. --�-- CA ; - Number of lines::_I......3--------------------Length of each ...........Width of trench--------2.-V..'...---1--- Type of filter mate rial._.__PjerC-------Depth of filter material-----_16.........Total length_.. --_-_*.....----------------- Seepage Pit_:. Distance o nearest well ___--- Distance from foundation..............A_--.Distance to nearest lot line................. i ❑ Number of pits----------------------Lining material-----------------------Size. Diameter--------------------.- Depth--------------._------_---------. k f Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.-_--.-_--__----------------------- -,..� - ❑- s Size: Diameter.---------------------------------..-Depth---------------------------------------------------Liquid Ca aci els. r Privy: Distance from nearest well-------------------------------------- `._-----Distance from nearest building--------=-----------------•-----•--•------ ❑. Distance to nearest-lot line------------------------- i Remodel' a�n /or re airin a ria r i f --- -- --—-•---- - ----- r . .. .;>, --------------- ---- -------------------------------------- - ------•---•---------------------------------------------------------------------------------.....---------------------------------------------------------------------- -------------------------------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe�.laws, and rules andregulationsof the San Joaquin Local Health District. {Signed] --------Z�ew_t- 040 4��1 ------ ,C 0V /WC— --- ----(Owner and/or Contractor - ---- -- ------- ------------- -------- --- . � ------------------ [Titlel 'r-d� By: C' ' ----- (Plot plan. showing size of lot, location of system in relation to wells,,buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------E--------------------------- ------------- -- - •------------------------------- DATE REVIEWED BY. -----`= x= ---------••------ -'-•----------------- - -- DATE....... '.- .... BUILDING PERMIT 155UED ------------------------- ------------------------------•------ .-- DATE------------------------- Alterations and/or recommendations:-1----------------------------- ---------------------- -•- - - --------------------------------------- --------------------•...---------------------------------------- 1 s , ------------------------------------------ ---------•------------------------------- _--•-------=----------------------•---------------------•----•-------------------- ------F------------•--•--•----------------- .........................-_1-------------------------------------- ------------ 1 f 1 ; --•---•------ -•---------------•..---•------..-.....------•-------•----------•--•-----•----------•---•---......-..-..-.-.--•-•---------------- # ti � 1 FINAL 'INSPECTION BY=------- - -- ------ -- ... Date..-..-. - '---- 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 EB 9 14EV15Eo B-59 2M 8.61 ATLAS ,