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* FOR OFFICE USE: Yk / • ' ---------------------------�----- / ----- --------•---....------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _1 ••-• --------------•----------------- ------------------- --- (Complete in Duplicate) Date Issued - --------------- This Permit Expires l Year From Date Issued ............... mag -r?o-o�f - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein descried. This application is made in.co pliencB with County Ordinance No. S49. MA�T � €�� "` .;'JOB,ADDRESS SAND�•LOCATION�I Dyy��_:- 14.CYMO-+��_.----- 211)----P4AG l ....... � Owner's Name � .� '.•�y -------------------• -------------• Phone . U -.{ - 1� ---------------I�l � .•--•---------------------- Contractor's Name-M NT'; CA..'__6_F-.t�:T-_! -.-. �-� == - Phone---.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of iiving units: -1--- Number of bedrooms .-��- . Number f baths .�L_ Lot size .__ �- &�f.................. i Water Supply: Public system ❑ Community system ❑ Priva#e Depth ro We#fir T'eble E'3 ft. + �' < P. ,� - L. we _ �_ xeF .1 �t�'�g r IR • .CIa Loa Cla Adobe Hardpan [_ Character of soil to_aAs th of 3 fee :. Sand ravel Sandy Loam y 1 -V Q Y 0 ❑ Previous Application Made: (If yes;date----- --- ----) Ncit Newt Construction- Yes No ❑ FHANA: Yes ❑ No 1� TYPE OF INSTALLATION AND SPECIFICATIONS: p cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distan Distance from founda+ion•-------------------Material....:_---......----._.............._.__________-- ce from Weare t well................ p 9 O SB�iP� +R�� "� } . p Capacity.. FX1�. ►JCS` No. of compartment ----------- Slze-----------k ------------Liquid depth ' Disposal Field: Distance from Weare t well �--------------Distance from foundation--•.-__.-----_---.Distance +o nearest lot line.---.....--.-.-.. 1 J lei Number of lines..,,- - --Length of each line---....--_------------------Vtilidth of trench----------------------------------- Type of filter materifal---------,---------------Depth of filter material------------------/...Total length----....--------_----__---•-----•---•---- Seepage Pit: Distance to nearest L ell---IOQ^_------Distance from foundation.... _...._..Dis+ante to nearest lot Ine__-_ -__.. , -----:Lining materialF -- -----Size: Diameter:. .__-- 0----..Depth--- -- ---:-____-- Number of pits_ --_ _..._ _ x-1 Cesspobl Distance from nearest well...............Distance from foundation--------------..._-.Lining material-.----------_-__----.___----..----- ❑ Size: Diameter-- -•_--- -•__-- Depth-------- ------- -Liquid Capacity gals --- q P ty--•------- --- I � y -- - �_*'1;?#P_D,istance fromonearest building-------------------------••-----•--------- privy; Distance from nearet well--------- ---------- Distance to nearest'of line- =-.x----.•----___--_ ;,rte li'l l�{'i' ,i i'�"�?�,�► � „t't� �. a -- -----------------•---•---------------....-- Remodeling and/or repairing (clesctibe):----------- ----------------••---------------•-------•---- II _...•• ----•--•-------•--•--------•------•--------•------------------• ------------------ -----------•--•--------•------•-------- ---------------------------------------------------------------------------------------------------- I I hereby cern that t him prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws,-andlr. a regulations of +he San Joaquin Local Health District. { l , /A, � --.----.(Owner and/or Contractor (Signed). s .....:... .......:: ..... � � - By:-------------------------- ••. -••-•-..i-- ----------------------------- '- ----------------.----------------•----(Title)-....-------------------------------------- (Plot plan, showing size of lot. location of system in relation to wells, tbbildings, etc., can be placed on reverse side). FOR DEPARTMENTYSE ONLY J� �� ' APPLICATION ACCEPTED BY-----T--�-�.�-�---------------------------------1�----•-------------------_- - DATE---- �--------------••-------- REVIEWEDBY-------------._---- --------------------------------------------1 ------------------------•-------•- DATE---------------------------------•---•--------------------- BUILDING PERMIT ISSUED------••------------------------ ---- ---- DATEAFFerafions=and%or_recommendations:: ------------ ------------------------------------------------------------------------ rr!°# .............................................-• -------•••------•-- ----------------•------------- --------------- -- ----- ---------- -------------- -- ------------- ----- •--------.-..-..-.... t, ------------------- FINAL INSPECTION B --- - -- --=- -- ------ date +�/ t 0� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sweet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS 1 yy.