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FOR OFFICE USE: Zo�. ------------------------ -------------------------------- ------- ----------------------------------- ........ --------------- --------------_______________________________________._____-.-...__._ APPLICATION FOR SANITATION PERMIT Permit Na. , .......... --------------------------------------------------------- (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ..2K3 ( q !tfo —tib 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 'n compliance with County Ordinance No. 549. LAT��O� x.4-77-i d_0-loo 45)])F_ /,, A JOB ADDRESS AND OCATIO �t-�`•�rvp------RR--`---- �F {1p Owner's Name----------- C C L ti 4® 1.17. �J _ _h'�........ . ....... .. 912.._ fi,?...... i -•-_•.---__..________._..._.____.----_..._..-------_._... Phone .~.. ........... Address t f� ... -g1 Contractor's Name....-W....... ljq-Tf�:FF.......... --------------------------- ----------•----.......---.._..................... Phone. ..'.3:'�/3.1 Installation will ee: Residence,®—Ap ment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . _. Number of bedrooms .ems. Number of baths _1'--•• Lot size .-1'7_X---9 ......................+ l Water Supply: Public system [Community sys -m ❑ Private ❑ Depth to Water Table S. ft. � Character of soil to a depth of,3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ^ , Previous Application Made: (If yes,date--------------------) No New Construction: Yes ;;�`No ❑ FHA/VA: Yes 1�-"No G ,__TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_N&E Distan a from foundation____/0-______-Material..0.011 KRJF_T` ......... No. of compartments,_--- .__ `Lquid deth-----_ � Capacity... -f?----- Disposal,Field: Distance from nearest weILN0JYF_.Distance4rom foundation Distance to nearest lot line......5 Number of lines............../_____..___"�".4Length of each line..- `-'"`-.Width of•trench____-_2*34.. ._.________...__ Type of filter matarial._._ Q_C,f�.___Depth of filter material..____! ____r"":_Total length`_`.______ ,� ...................... !Distance from foundation....................Distance: Seepage Pit: Distance to nearest well-------------- ------- to,e est lot line............... ❑ Number of pits----------------------Lining�r;aterial-----------------------Size: Diameter--------------'Y---Depth-'%----------------_---_---- Cesspool: Distance from nearest well______________•_Distance from foundation-------------------.Lining materialA_ __._._................_. ❑ Size: Diameter-----------------------•------�._Depth-----------------------------------------------------Liquid Capacity`------------------------gat$. Privy: Distance from`nearest-well" -77-777-77-77- -.Distance from nearest building..........N --.----;•................. Distanceto nearest lot line-----------••--••---------------------------�------------•-•------.....-------------------•---------•------------�-�-..�.._ ------------- 1 5. � '10 1- i 1 II Remodeling and/or repairing (describel:_ �_ _ !{z_ ...... 1 R __f., _Pi tr/ I1(..... 42F=....%M,—E(Cid F1 t-LES--- W-1-T-H------ l�V t/ s_' :=. too GK F N� .l--•-------4:0Nr6TE .-----.$R4_TH0FEZ ID?tTto 7N ® 4r° ......'T,ta = t - • ---------- '" =- ' E1D1�tTiQn1------fir------ROCS. '-�- 84R- �-- -1� T'�---Z Q I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CountyT ordinances, State laws,jand rules end regulations of the San Joaquin Local Health District. ' -----------------------------------------------------------(Owner and/or Contractor) (Signed) -- ....... t.. f3 - ......................... Title --------------- _41 - '^ y _ - v -_ - - ----_--------------------- [ � ------------- ------ ..----- __ (Plot plan, showing site of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------—7 •_ ,------------------------------------•------------•--------------- DATE------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE. Alterations and/or,recommendations-..----•-----•-•---------- - - . ___.._,. �..�...�.�....► ------------- .._ ---------------------------•---•-------•---------------------------------------------•-------------------------------------------------------------•- •-------------•---••---- ---------. ---••---------- �! r•f k # ' � E,► T 4a ! A _ . ,f ................. .........__....._...._:------ . ------..-.-------------------------------------------------------------------- FINAL INSPECTI — -- Date----- ------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 2 130 South American Street 300 West Oak Servet 124 Sycamore Street 205 West 9th Street Stockton,California lode,California Manteca,California Tracy,California ES 9;REVISED S-09 pM 5-61 ATLAS J� 3