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FOR OFFICE USE: --_' --------------- APPLICATION FOR SANITATION PERMIT Permit No. . �� %_�,------ ------------------------------ - - ------------------------- - ----------------------- i (Complete in Duplicate) Date issued ------ --------- -- --------- This Permit Expires I Year From Date Issued .. .._.__ /........ n Application is hereby made to the Sen Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5.49. C'oN6;C Jac MAJC 0 ethilsAt JYWAY .M f-, s<,F, cW JOB ADDRESS AND LOCATION--- >U-..__&X__x30_y------- ------------------------------.-----------------------------------------... Owner's Name------ 7 ; --------- /�1.l�L Q-------------------- - Phone----------------------------------- Address...................... ---------------••--Address---------------------- �•-�x6]-!_".RA......._..--•----' ---------------------------------•-----------.......------ Contractor's Name------. ---------------------------------•----------------- - PhoneA". _*00f_7----- Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms . "-_- Number of baths/__YLot size ..../0�-__-_ 4 5__-.•____________________-"":. Water Supply: Public system ❑ Co4 muriify system ❑ Private RrID-epth To Water Table 16T_ ft. Character of soil to a depth of 3 feet'a Sand F] Gravel ❑ Sandy Loam E] Clay Loam ®'®' Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No e New Construction: Yes ❑ No Z-_�FHANA: Yes ❑ No ❑ Go TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) }- Septic Tank: ry.Afr,Distance from nearest welL___� �__Distance from ioundation-----f4P__-____.Materjol______ _. R p ents..-_._--• _ Size--•--.-. �__ S ?.._..__. -------- Liquid depth -' .........Capacity.... Disposal Field:1 Distance fromrnearest well..5r-1-----Distance from foundation....�c4'_'____Distance to nearest lot .___.... P �] Ex�Tj Number of lines--``--------f-------------------Length of each line........-T0-------------Width of french:........7. ----------------- ADD Type of filtermaterial._._ 64► .,----Depth of filter material_____L�r��____::_Total length-------------�i'0.�----._............ 1 I Seepage Pit: Distance to nearest well----------------- from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining'material-----------------------Size: Diameter------------------------Depth----------.______.___-_-________- Cesspool: Distance from nearest wells"-_-____'__---Distance from foundation--------------------Lining material--------------___..__---._--____-_•_ .7 ❑ ]c ----------------------------gals.Diameter---------------- - -- Depth----------------------------------------------------Liuid Capacity Privy: Distance from nearest well____"_-------------------------------------------------Distance from'nearest building___-____-________________________.._-_---. ❑ Distance to nearest lot line----- ------- ------------------------ --------------------------------------------------...........----•---------------------- l Remodeling and/or repairing (desci6 )------------------.09_,D_ -------- --o. ... /!?._.....-•---....-----------•- --------•-•--•---•---------------------------•---------- -------------------------------------------------------------- --------------------------- ------------------------------------------ 1 I 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. e i (Signed)----------- _' ,.__ C!✓Jr>Lc� -.- ---- ---------------------------------------------------Owner and/or Contractor) I By:............. -------------------------------------------------------•------------{rtle)------ - -. -.. -------------- (Plot plan, showing size of lot, to tion`of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _-__. ` """_ "a""`DATE_____' G�''�j'!__ I / �__ ._ -- ------ -- REVIEWEDBY ----------------------------------- -------------------- ----- DATE BUILDING PERMIT ISSUED......... ------------------------------------•-- --------------- DATE----------- AFterat'ons and/or recommendations:_.___,- i � ` ......... x•---- G Jk �1 ------------ ------------------------- -------------------- t� fi .......... ----L --- - Y- [�� 5� l �' .i p !�'f'"-^G7�f�= FINAL INSPEC ON BY � _.� � R, , Date------------ �---`-€----------------------------------- A,", SAWN JOAQUIN LOCAL HEALTH DISTRICT 1.30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS