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FOR OFFICE USE: ------------------------------------------------ �•.i "i. _..._______________________-------...._____._--_-__.: APPLICATION FOR SANITATION PERMIT Permit No. --------------- -------------- ------------------------- (Complete in Duplicate) 9 t- pDate Issued ------------------------------ ------------ -- --- I 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..Counfy. Ordinance No. 549. C. r , JOB ADDRESS AND LOCAT ON_._.__. ��i '�4, _____.._ - 0E &To ___ fes"• •_�___.... a... __�_.__ _____ __ Owner's Name--------- l-------- -� Uksr (f --------------------------------•---------- ' �� ------- Phone_......----•-•-----------------•---- � Address_-....____._1_`�>> ..... Contractor's Name--- 1113aTti!;�6.......`� � rf SAF iafz -------------------------------------- Phone................................... Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: j_____ Number of bedrooms _3_ Number of baths Lot size .... =C-�1 &. _____._..._......__ Water Supply: Public system [3 • Community system Private ❑l Depth To Water Table .�___ ft. Character of soil to a depth of 3 feet: `Sand VGrAxel.❑a.Sandy Loam El Clay Loam•❑-'Clay_❑ Adobe❑ Hardpan ❑ a Previous Application Made: (If yes,date __ ) No I New Construction: Yes 'No ❑ FHA/VA: Yes ❑ NoZ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I �R.E Ft9 Septic nk: Distance from nearest well---4� �s-----Dista Jc from foundation-_.../ -------- t rial <72A,- - r -- P �.-------------Size__�X--�-X-5----•-•Liquid depth--- ------- ------------- P Capacity � - No, of compartments .Ca aci Disposal Field: Distance from nearest well--, ( _---Distance from foundation�t �_____- istance to nearest lot line__-.. ' Width-of Typebof filter material . ��_ �1.Depthhofffilter�m:ate al----.f�"___._:otal- length nch----� _r_._...�---- I ! Seepage Pit: Distance to nearest well_________________ __Distance fromtfoundation___•-_..•_______.__.` stance to nearest lot line................. ❑ Number of pits----------------------Lining material:y=.___-----_'---- Size: Diameter:_.4......-----------Depth-----------------..-----.-------- ..r v •------ w S- -- ... Cesspool: Distance from nearest well-------------'__Distance from foundation....-!--------------Lining material.-.-______-.___•_._-_-----___________ ❑ Size: Diameter------ -•---------------•-------- ELEDepth-------•-------------•-•--------------1------------Liquid Capacity-------------------- Privy: Distance from nearest well--------------i--------------------------.-------Distance from nearest building_________._.__-_____________-___.____.._ ❑ l -- _, Distance to nearest lot line ----- ----- -- ------------------------------•---------------•---•-------------- -------•---------------- Remodeling and/or repairing {descrif�e�__________________ ___ ________ r� --------•------------------------------------------ -------------------------------------•------ ----- - --------------' . -------•------------------------------------------------- ---------------•------------------------------------------•-----------------------------------------------------------------------------I-----------------------------------------•-----•----------------------------------- -.I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta% aws ' ndrularewlations of the- San Joaquin Local Health District. (Signed)- / -.--- -- -`• /Cl/"�`- --------------------------------------•------------------------------------- ---------(Owner and/or Contractor] BY: --------------•-------------------------------------------------•---••-----------(Title)--- ::4 __ -'-----_- �,<�; 1 (Plot plan,.showing size of lot,.. cation-of system in.,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY• ' APPLICATION ACCEPTED BY.-t------ t `------------------ -----------------------•------------------------ DATE--- REVIEWED BY------------------------------------------------------- ------• DATE BUILDINGPERMIT ISSUED------- ---------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or re commencra4ions----------- -------------------------------------------------------- --••-_---•--- --------------------.-.-----•----•--•------._------------------------------ -•---------•------•--------------- ' -- } -------------------- .............. -------- --------- ---------- ----- -- - - ------•------•---------------------•-------•- -•------------------•-------------------•-------------------- g.... FINAL INSPECTI Y: -- ----- ------ ----- Date------7--l..l...- 41�,. ................ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,Callfornla Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS