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FOR OFFICE•USE: ----------------- - APPLICATION FOR SANITATION PERMIT Permit No. __ :'_._ :y.__ , - (Complete in Duplicate) Date Issued ------------- ,y,. - ----------------- 'This Permit Expires 1 Year From Date Issued ��F_ tf 0 —Zb 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,complie ce-with County Ordinance No. 549- WNT-F—=C04- r j-0-9 ADDRESS,AND LOCATION_(_ lrow---------- v.R.e -T----------- " =4.B1�RT"---------G_RtS PAI--------------- Owner's Name ----..... _ -------------------------------------- Phone . l - Ph - t ------------------------------------ Address ..-------•--- ---...---•--••------y Address---------- � -------� -----...1AT-Hpo-P------- --------------------------- � 1J.Contractor's Name-----0 •---------------------------------- ------------------------------------ Phone...........-----------••-------- lInstallation will serve: Residence Apartmeet=House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t Number of bedrooms _ __ Number of baths .42-7 Lot size --------�...... - -'............. a Water Supply: Public system El Community sy tem El Private 0'/Depth To,Water Table Character of soil to a depth of 3 feet: SandwGravel ElSaiidy Loam Clay Loam ❑ Clay E] Adobe E] Hardpan ❑ Previous Application Made: (If yes,date____________________) No 12/ New Construction: Yes U�'No ❑ FHA/VA: Yes ❑ No W - TYPE-OF INSTALLATION"AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic nk: Distance from nearest well__�O-----Distance from foundation_--_/C...y..M at ial_./ 7 ��.Q.... :!1=__Tw } '� Ca acit No. of compartments.-----2------------•-Size. ./?_,._, __ Liquid dep �.p Y =v ` Q... ?--Distance to nearest lot line-___ ....... Disposal Field: Distance from nearest well----�V--._Distance from foundation ft :.Number of.,lines___.'..- -- _..,_- ILength of each line-- ----- --- ---' Width of trench----l�.r_-- ---------.:._ Total Ian th (�---•------•-- �.. Type of filter material—R0 G_--;Depth of filter material_____ .. __�_ ._. g Seepage Pit: Distance to nearest well _____________________iDistance ffrom sfour an ion....................Distance to nearest lot line................. I ❑ Number of pits -- ------t--6- ---Linin mat' real Size.- Di'ameter------------------------Depth-----•-.•-------•-••---------_-•• Ih— f � Cesspool: ] Distance from nearest, well___.__._____..-.Distance from,fbundati n__-i________________Lining material__:___-._..._,____--___.___.__-----.- - _. 3 `+4 . ❑ Z Size: Diameter - ----------------------.Depth-------- LiquidCapacity gals. r . Privy: # Distance from nearest well__________________________ _____________________Distance from nearest building___=_-...--.________:.___________--.-.:.-. Cl Distance to nearest lot line..____.___ I - -------------------- hamar..1�-�i�tT-----aF.�-l,.-�-------�•�-��.,- �'i�"3�"!�f-1s:1Z=H-T`ffiiYi� ,Q Remodeling and/or repairing (describe):---4 ----S -TSN-----1�1 1------BAnO.6---_-ir'�-1�__1-0 - --.._ p_I ...P1 PI_ '__�h�---� � -- --------- ��; F------� 0AA!_ �-4 ems--- rte-?powo -----3�---o,- i- � [3rli _nf.. � d ; l T�� ! oKnl 3._.'►_ �'1 ..__` "!- �I ` _.�_ry_75T A------O�----5V�1 ,c ��a-----�.nf k--Ll At_9--- �'--N�=�'-------- 3°------PHEW!__/a � t----I I hereby certify that-I have prepared this applicatibn and that the work.will be,donelintaccordance with San Joaquin County OJ ordinances, State a , and rules and regulations of the San Joaquin Local Health'District. Owner and or Contractor SI ned / I 3 Ti#le By:•--••-----------------------•------------_-- --------_---------------------- ---------------..-------- { (Plot plan, showing size of lot, location of system in rely on to wells,;buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY 1- 4 ..'. I APPLICATION ACCEPTED BY- -. l.-.tQ. . .----- - �- -- �� -�,�„i --------------- •• -------------------------• ---- DATE_.___I_�...�-�..__� -- � - . -------- ------- - REVIEWEDBY-------------------------------------•------ - - -----------------------------•------ ----------------.... DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---- CJS--�3 �,l pfz - (S,_-__.Ti_ .�------ DATE--------------------•--------------------------------------- I Alterations and/or re mmenda+ions: - -� ' Q ' ---- iOf � 2-s�3 - -------------- ---------- ------------------- ------------ t --- ., Z - a .�. .--�------------------------------------ •1 �.�.,----------------- i --------- -------- , -- y y r ', -------•------1_- •-•-----•-------- --- -- --- i ' -------------------------------------•----- ---.........-------• r "`. ------------------ FINAL INSPEC�&N__BY-- - - ------ --- Date--------- r SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' r; Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS r