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FOR OFFICE USE: F ------------- ----------------------------- -- ---------- ------------------ -------------------------------------- ---------........................................._-__:______-__- APPLICATION FOR SANITATION PERMIT Permit No. .1... �: ...Z`1-- -------- -- -- ------------------------------------------ (Complete in Duplicete)g '�+ M1 -ba' -•- Date Issued ___% .�/7,/�__�� --------------------------------------------------- I This Permit Expires 1 Year From te Lssued t Application is hereby made to the San Joaquin Local Health District for a perrfii4c,construct and install the work her In described. This application is made in compliance with Cou ty Ordinance No. 549. j¢,QfJ : 7 I"��h'Op• l JOB ADDRESS AND LOCATION_510 ---- ----- -------- ----------- --i ��dl- -------------- 1 v-- - - 1 Owner's Name_. �.' E A -•--�-----R -------------- --------- '--•--- ............... Phone.................................... �- 'T-A N Cont asctor's`N e---- ....5. --- .. _j RPPR�------------�-�---- !--- ---•---"------------------------------------------------ Contractor's --------••-------------••--------•------•--•- t / '� ------- ------- -------------------------- Phone................................... Installation will serve: Residence ®partment House F Commercial ❑ Trailer Court ❑ M tel ❑ Other ❑ Number of living units: __�_�dmber of bedrooms __Number o bafhs*l I 7:-: Lot size __..f ._e C �S�-- PP Y y ty sY ap[5— W PWater Su I : Public s stem mmu�r• � •stt3171 Pri�ate �e t� T Water Table _� ft. Character of soil to a depth of 3 feet: Sand [ravel ❑ Sandy.Loaf lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: (If yes,date---- ------A-�rl7IN,bt . New C,nstr ction: Yes ��o ❑ FHA/VA: Yes ❑ No _—TYPEOF INSTALLATION AND SPECIFIC TIONS: Ai (No septic tank or cesspool permute if public sewer is vailab2fee/+.) Septic ank: Distance from nearest eIL_e .� ------Distance f_ro foundation____l_�J___.__.Mat rial__ '.✓� � ..____Capacity - .}..__ =� No. of compartments_.____ _, -__...___Size__ _Y__L_ °.Liquid depth_____ __...�-.____- ____J _._. i t Disposal Field: Distance from nearest weilC4 - ___Distance from fd red tion __�0__.___.Distance to nearest lot line_f__5....•. . � Number of lines---------- __ _._-_____Length of each I}ne__ ___ t�__ i Width of trench.__-_-__Sk ---------------- Type ____---__-•_-- Type of filter material._??O-C-K,----Depth of filter Q „ate„rial__.f ------------Total length__________________ ......... Seepage Pit: Distance to nearest well----------------------Distance from founpation--------------------Distance to nearest lot line__._____•-_-_----+ Z ❑ Number of pits-+--------------- --Lining material--------•-------'C ize: Diameter____.....--------------"Depth___.------------._--------...... i Cesspool: Distance from nearest well-----------------Distance from .foul ation...._.___-.______-_.Lining material-----------.----------I..........____ ........Y,,,.., ,.. '�"..'"". °' -------Liquid Ca aei gals. ❑ Size: Diameter------:;�°".�'.".'"...`................DeiifFt...---....------=•----��--:-------------------- 9 P �tY=--------------------•-•--•-9 ' Privy: Distance from nearest well______________ ___ _______________ __ Distance from nearest building__�____--.-_-__-____-____________._.___--- ❑ Distance to nearesi lot lin"e'y' e`=' t _' 3_____c�-.____-__ _ • t 1 -„__,_____._,� _•___-t-• ,-_-- _•-,.__••--_Remodelin9 and/or repairing (describ ) - ---------------------------------------------------------�------- - -------------------- -----`--”- 7------•---------'-°--------------------- f ----------------------------------------------------------------- -------------------------•---------- ► ------------------------------------------------------------ ----------------------------------- --- ------------- ---------------------------------------------------------t..........----.--_------------------- I hereby certify that I have prep ed.this�appplicatio l and,.Aa+-the,awork will be done in accordance With San Joaquin County ordinances, State laws, and rules and regulations of t e San Joaquin Local Health District. Y _(Signed)---------�'4�.-�- ' ----- -------------------------------- ----------------------------------------------------:-------(Owner and/or Ccntractorl� : By:.......... ...........• -------------------------------------------------------------------------------- -(r+le)------------- (Piot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY f e r„r t i 1,4v �( APPLICATION ACCEPTED -------------------------------------•----••--•----•--------------- DATE-----. ----- J -i -------------- REVIEWEDBY-------------------------------------------------------------------------•----------------------------------------------------- DATE------...-..--------•----------------------- 1 BUILDING PERMIT ISSUED------------------------------------- ----------=--------- DATE Alterations and/or recommQnd'ations:-------------------------------------------------= ----------------...---...:--•------------------------------------------------------------------------- ------------------------- /� e D ~i55 O �� `--- �-f 0 �' --�`------------- 7_A��-----'------------------- ----------- --- ---------------------------- __.. ` ----- F_-7-�ED---,_.- _T. 1--•-- ----------------------------- AFINAL fNSPECTIO _ - - - 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 Montego,California Tracy,California 1 ES 9 REVISED a-59 2M 5.62 ATLAS R' - 4 '