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t FOR OFFICE USE: ------------------------ ------------------------------- ---------------------- ------------ ------------------ ------------------------------____________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..,f_..�P.� --------------------------------------------------------- (Complete in Duplicate) Date Issued --------------------- This Permit Expires 1 Year From 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 application is made in compliance with County Ordinance No. 549. 21(-5 2- 2E�Sb A S . �c.�,r z��,. ✓�j ...�--- JOB ADDRESS AND LOCATION-------1r ---,�--------- :!�'Y ------•f6�---------- --------1 v------B-ip.czk Owner's Name----------------R AI.?--h-•----•------ ! ``5 p --------------- -------------------------------------------- Phone.47�5 Address-------------------5�/''!. i 5------ ----------------------------------------------------•- ---•-•---------------------••--------------- Contractor's Name e-.--/941-,7�n � ......... ....L./f1_ E'S f0 Phone/ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other J& Number of living units: .._..... Number of bedrooms ________ Number of baths ........ Lot size ..©Ye?�__......a. � ...................... Water Supply: Public system ❑ Community system ❑ Private J4 Depth to Water Tabled_ ft. Character of soil to a depth of 3 feet: Sand od Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [3 Previous Application Made: (If yes,date____________________) No X] New Construction: Yes A No ❑ FHA/VA. Yes ❑ No II TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T r Cfas - - Septic Tank: Distance from nearest well--- - _Qts{ante from foundation---A?. C..Material.___ f-Koly�? X79 a� No. of compartments---------,�-_________.__SizeA/X__,4"_,-,r__/0___-Liquid depth........y '____Capacity..I-;Zw Disposal Field: Distance from nearest well._-300_F7Distance`from found8tion__1x..fiT___.Distance to nearest lot line/ Z9�.. Number of lines______________ _.------------------Length of each line-------- of french._.36'__% __________....... Type of filter material. _&Q G&__-Depth of filfer material_*--A_l�N_____-Total length.......AP._.A.-r_______________ 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------------------------------------- ❑ 't Size: Diameter--------•---•-------------------------Depth.-•-------•-------.-•-------------------------------Liquid Capacity.--------------------------gals. Privy: 4,, Distance from nearest well-------------------------------------------------Distance from nearest building_______________.____.._.____________.-___. ❑ Distance to nearest lot line___ _ ,! Remodeliny9 Ind/or repgiring (describe]:__A�I ._. !q1../1-.------•` .?!------/�j1_.f?_'��'_v........ u L /�' ... /T. '- •---•--• !.'Y `•:/••f mor ,Rn ' -s .._J�t�r= �� ll ¢---------- e-------A17c-.-N-.4-Tc---•--W45. �->---------Az---------4 t&e--l��'^-�r -------pf,�------sWi-I-e-------------------------------- ------------------ -O A r'°------------------------------------------------------- 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 S Joaquin Local Health District. (Sgn`ed)... _ ........c------_ 4. y._--------------------------------------!-----------------------(Owner and/or Contractor) s 9 y. (Title)---- ,��--_ = r lP� --------------- J(Plot plan, showing size of,lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY. ' - -- - � APPLICATION ACCEPTED BY------------ --►--F'-•�2-------------------------------------------------------------------,DATE...••2-•=-1•---; REVIEWEDBY----------------------------------- --------------------------------------------------------------------------------- DATE------..__...-----------•-.._.. BUILDINGPERMIT ISSUED-----•---------------------------------- -------------------------------------------------------(DATE--------.-..----•------------------------------ Alterations and/or recommendations:.--- -------------TAUK......jp .T`Ai l- ------------------ ------------------------------------------------------- ----------------------------------- ---------------------------------------------------------------------------------------------------- -- .----•-------------•---••--•-----•-•-•• i------ ----------•-----•--------- --•-------------------- ----- - --- ------------ ----- -• / ----- FINAL INSPE�IGN __-- --- -- Date----.------- _.-r__!.. r 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 ES 9 REVISED S-89 PM 8-61 ATLAS