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FOR OFFICE USE: t)DAry 5 , CAI- ------------------- AL_ ------------------ ------ APPLICATION FOR SANITATION PERMIT Permit No. ._,1*s....... ..... -------------------------------- --- ------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is lf`ereby 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. IM19t-,TECQ r % JOB ADDRESS AND LOCATION......6 DF_--©F----Li-'TH.R - h-�-w © � Owner's Name-------------- � Ll�. f'7� -r, d: ------------------------------------------------------- Phone.................................... Address------ --- -- - -- �-- � ak-------3-41�-----.11 _�4Tg ------------------------------------- ----------------------------------------- Contractor's Name---RF....--P-��_ �Rr�qt-Kiil)-t-----------------------------------------------------------------•----.. Phone.. --77..7. Installationwill seryIF e: Zesidence [Apartment House Commercial E] Trailer Court ❑ Motel C] Other El Number of living units : .____. Number of bedrooms. Number of baths �. Lot size .......1//16 C] ~�................... �� Water Supply: Publict system ❑ Community system E] Private VDep.th o�te"i*Table -S. ft. Character of soil to a 8epth of 3 feet: Sand Gravel [:] oam Sandy Loam e Cla ❑ Clay ❑ Adobe❑ ;7NO an ❑ r i Previous Application Vde: (If yes,date----------------_--) No e New Coir fr�4ion: Yes eNo ElFHA/VA: Yes ❑ TYPE OF INSTALLA ION AND SPECIFICATIONS: (No septic tan 'or cesspool permitted if public sewer is Vailable within 200 feet.) Septic Tank: distance from neares well_.__.-_..__. 01stance from foundation............. Material---------.-........�......................... Yl} AIC— o! of cvm artments- • 5ize--------------- Liquid de h--------------------------Ca ac 1 r�fir,..-►,A^-"� v f Disposal Field: islance from neares. well.-��------Df#tAAdd-fr0foun tion....Aa_- ..---Distance to nearest lot line..-+S--..... Number of lines---_---_- lE _- Width o trench.----- �r_._ - FKW I�I`a - -------"Lg� rl� li e.. �e� f' t T e of #iYnearesf aterla. �. _De th of filter ma erial--_- Total len h._ _ ---..-_-- D D- Iy i""" ,tp --1ISeepage Pi#: [ s#anc elt----------------------Distance from fo n a ion---.____.--_ -_-_.Distance tonearestline...-_-_-_-_--_-._ ❑ �1uitnber of pits---------- -----------Lining material----------------- ----Size: Diameter-----------------------Depth--_i---_-----_._- Cesspool: Disttance from neare well-----------------Distance from f ndation._---------_ --__.Lining material -_----t_---_---_-.----.--.-. ❑ fiz V Diameter----------- -------------------------Depth------------------ ------------------------- _-Liquid Capacity----------------------- gals. Privy: Disance from neares ell -------------------------- ------- ' istanr;e-frommearest building----------•---------.---.-.---------__-_-- ❑ Distance to nearest lot line-------------------------------- - ---------- ------------------------...----•-••-•-----...-----•--•-••--•-••---•-------•-------------------- f - f }� Remodelin and/or repairing describe):-------A-DIN-�CQN------ --- rQo-.f.? !-N T ------------------- ----------- i - • - •--------•-------•----------------------------------------------------------------------- y ----------------••------------------- f -------------•- ------------•--------------- ----------------------------•--------------------------- I hereby c,r+if�'+At I have prepa�e� } i's gpplication and that the work will be done in accordance with San Joaquin County ordinances, State lames s and req-` )ations4f the San Joaquin Local Health District. f �- (Signed)-- { - -- ---•----•- -- ----------------- •-- --- -- ---------------------•---- ---------------------(Owner and/or Contractor) BY� ------------------------------------- •- -..,:.....--.-. (Title) (Plot plan, showing size�o+lotrxoca+ion of system in relation to wells, buildings, etc., can be placed on reverse side]. k R DEPARTMENT USE ONLY i WE APPLICATION#,ACCEPTED -----• DATE-------�--•"4- - ,.,��_.. --------- REVIEWED BYJ------_---------------------- Z. ---------------------•--------•------------------ . DATE------------------...................................... BUILDING PERIMIT ISSUED ----------------------------------------------..-------------- DATE----..._------------ --- Alterations and/owre�mmendations:,.-- _�_ --------- ------------------ �- -".gin_"------:----W--------- = • 4 ----------------- � '� : M... ..,�....... 7 + t --------------------------------------••---•-•-•---- ------------- -----------------------------------------••---------- -------------------------------------- -------• •-------•-----------------•----•---------•---...--------•---..__.._.._...-----•-•--------------. -----•--------------------------------------------•--- ---- -•------------------ - ----- -------------------------------------------------------------------------------------------------------------------- ------------------ FINAL INSPEC Date �.r ;J -� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Svr*et 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS �r r�