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--r- K Jrr,I-r -- /------- --------- APPLICATION FOR SANITATION PERMIT Permit No. —13 3 j3 ---------------------------- --------------------------- (Complete in Duplicate) ---- ........ This Permit Expires 1 Year From Date Issued a Issued .. ................... � r'�Tia'�.ca.z Application is hereby made to the San Joaquin Local Health District for a permit to construct and -1n—sf7anhe work herein described. This application is made in compliance with County Ordinance No. 549. (f JOB ADDRESS A LOCATION._--(Q- ------�,,.-- •- - -- �----��____-•__-•-- e- Owner's Name- ------- ----------- Phonig,�.�ca ?--`�. •� Address---------- a� Sj Contractor's Name...At, f !5-... -•-----•-------••-• - --------- Phone.................... Installation O 1.1kwill serve: Residence dApartment,House,B Commercial- —Trailer'Court ❑ Motel ❑ Other ❑ umber of living units: 1.__-_ Number of b edroo�m j - ��aLt ._ _.__ Lot size .__�_�.�__,(.(.�-�.......... .-- I - _- u _�Number of,-b Water Supply. Public system ❑ Community p tem,❑ -Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loa ❑ Clay ❑ Adobe Hardpan ❑ Previous 4pplication Made: (If yes,date----------- --- No ❑ New Construct: Yes P11No ❑ FHA/VA: Yes ❑ No ❑ TYPE OFINSTALL4TION AND SPECIFICATIONS: " 5' r �� (No septic tank or cesspool permitted if public e e is available wi#liin 200 fee#. Septic Tank: Distance from nearest well_ Distance from foundation-- Material.. _ pWD>DD Dis osal Field: Distance from nearest well_00 etDistanle from fog'-u dation-!. 11-r �( No. of compartments------- --------------Size-j1:1(-•9-X.,' -Liq ,QeF?th 171 -------------Capacity...lefrd --s"�'.�- P _--__Distance to nearest lot line. .__... Number of lines-----------/....... I------ Lep th .` ,�_� ---Width of trench.---off-.f "... Type of filter material__.-�p ',/ _-,-De th!of filter ma#area r � sof each �ne__.- YP 1== 1 Total length---------- ------------ Seepage Pit: Distance to nearest well-------t)-------:___Distance from foundation____________________Distance to nearest lot line.____._.____.__. ❑ Number of pits---------------------jL�ining;material1----------I --.----Size: Diameter-----------------------Depth................................. Cesspool: Distance from nearest well__________________Dista ce fro'# foundation--------------------.Lining material__-.----_ ❑ Size: Diameter------------------- 1------- ---1 - Depth-------------- •--••----------------------------I----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_ stance from nearest buildin ❑ Distance to nearest lot line---------------------------- g j Remodeling and/or repairing (describe)--------------------------------------------------------}_-•---- s� --•-------- --------•--••------•---•-----••-----------••------•--..---- ---------------------- ---•--- ------.-'----------- °' ---------•----•--------------•--•-------- ----------j--� --------------- •----- � ------------------- Y Y prepared PP icationM _ r- - ,_..'_______ and that'the work well be done:t ordinances, Statecertify and h rules and regulations o+ n accordance with San Joaquin County g � he Sante Joaquin Local Health District. (Signedif) ------------------------------------------------------- ---------------------(Owner and/or Contractor) B : - Y Y --••----------------- •• (r Nle) ---------------------------------------- ------- ------- (Plot plan, sholing size of lot, location of sterni in relationto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----> . _ - .__ _ DATE.... •----"--�--'-.�._ ------------- •- REVIEWED BY---------------- - - =- : ±° ---•------..-- . .-- ----•------------ BUILDING PERMIT ISSUED--------------- 4-••------------------------ -------*`-- --------------------•----------------- DATE........................... Akrera 'ons awl/or recommendations: ------------•------------------------.......---------------•- --••--_...----_----• ----•_.._. -�"=--••- -`-, -. .. ____: 5 -f d�+s�/+` i/z•�_�_ R-*-- -�• - C� s...-7-L.i-�-.- r±-- rr-�S -G� i yl•-------- ---- p------ ------ ---------- .----.... - ------------------ ----- -------- ------• -- ----- ------�-�---��...-�------ FINAL INSPECTION BY:---,- --- l - ------ - ----- ---- Date-------�- o .�o SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street '300 west Oak Street 124 Sycamore Street 205 West 9th Streetr Stockton,California Lodi,California Manteca,California Tray,California f C8 9 REVISED B•$9 2M 8-61 ATLAS + . J