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FOR OFFICE USE: " ------------------- -------- `- _ _ ______ ____________"___. APPLICATION FOR SANITATION PERMIT Permit No. 4_411__ ----------------- -------------------------------------- (Complete in Duplicate) _cf This Permit Expires 1 Year From Date Issued 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'applicatiort is made in comp:liancwith County Ordinance No. 549. JOB ADDRESS AND LOCATION._12 " + 1T l��(—n�yip_p�- Owner's Name `S7fll1( 'f ----- 'r4 'tt_7.. C'�. 1�"------- ------- ------ ------------------------------ Phone.0_0'7C1�;.7 / Address / 5.4J= jNQ-. R/.k .�eC' RT- n 'I.. Contractor's Name s._. l3.R 1. 5/ .-�0-'-V:S' 1�1�------•--------•------------------_- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size _____ 8irn.247.5 ---------------- Water ... ........... , Water Supply: Public system ❑ Community system ❑ Private [jU Depth To Water Table ---y--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No o New Construction: Yes 0 No ❑ 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-_.5--o... ell__ .5--o.__.Distance from foundation____f¢ Material--- ie-CP Irs'7 No. of compartments..._____.2..-----._.-___Sizer'+_�o ` t_� :z Liquid depth-----�. -".._Capacit-- --- Disposal Field: Distance from nearest well__ 610-'.,_Distance from foundation.__...�C�_�.__..Distance to nearest lot line_•_-. ® Number of lines............._`L__----------------Length of each line---------L4_0............Width of french--------- Y__ Type of filter material.-Pq-YC-------Depth of filter material--------- td_"....Total length------------�P...Qt_----------- Seepage Pit: Distance to nearest well--------- -_______Distance from foundation...................,Distance to nearest lot line.__--------------- ❑ Number of pits----------------------Lining material__.--------------------Size: Diameter-------------------------Depth-------.------------__---_---. -- Cesspool: Distance from nearest well-________ ______Distance from foundation.__-----------------Lining material----------------------------------- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------.-Liquid Capacity---------------------------.gals. Privy: Distance from nearesf well----------------------------------------- _------- Distance from nearest building------------------------------------------- --------------------------------------------------------------------------Distance to nearest lot line Remodeling and/or repairing (describe:---/9/?Q---- _---,ST��2---- tJ ------X91..�Y__ISMS .......................... -- ---------"•-------------------"----------•--------------------------------------"-•------------------•-•---------------•-----------•--------------I-•-----------•-----••----------••----------------------------- 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)---....S_0�_-Pct-1--- ...,�----!�O�------s�r�------------------------ ------(Owner and/or Contractor) t By:.......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on 'reverse side). ,FPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- fir' DATE_.. �l- a-. 3 ---- REV I WED E -- I -- E ------------------------------•------------ ----• - DATE--- ••------------ BUILDING PERMIT ISSUED. --------•-•------------------------------- •------------------------ ------- - --- -• -------•-- DATE_._. Alterations and/or recommendations:-------------------- ----------------------------• ------------------•-----------------------------------I-I------------------------------------------------------------------•---•--------------------------...---•---------------.....------------------- -------------------------------------•------------- .--------------------- -------- FINAL INSPECTION 8Y _.. .. - -� ---- --------- Date_ ----- SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American Street 300 WestOakSrreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS //.1 oe-l�• r. - S -� .144 4�_