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FOR OFFICE/ SF/' APPLICATION FOR SANITATION PERMIT Permit No. �. 3 -------------------------------------------------------- (Complete in Duplicate) J { ---------------------------------- ----____-_.__ This Permit Expires l Year From Date Issued_ Date Issued ....,<..-.-•--.-..-_7�.- d Application is hereby made to the San Joaquin Local Health District for a permit to construct nd install the wor h9rein described. This application is made in compliance with County Ordinance No. 549. j`p-2- JOB ADDRESS AND L C TION--- r - -��-�'-00- - n_r� S,/ e..�-f'-- n�0df.R'1..-.:lv�. � . Sf.1 "_.L_h_G�rx�/QY!!� Owner's Name----------- .I~ .......... -�-� ------•----.- Phone............--•----------- Address---------------------------•- `�" Q ------......--------•-•-••--•-•------------ Cantraetor's Name -� TC? :-; eGl Phone f Installation will serve: Residence 3 partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- .___,Number of bedrooms.... Number of baths .!__-_ Lot size ---_--_--.._.•----:-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabled54 ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sand Loam [I Clay Loam ❑ Clay F] Adobe ardpan ❑ Previous Application Made: (If yes,date---- ------------__.1 No New Construction: Yes B--No ❑ FHA/VA: Yes a�—f�o TYPE OF INSTALLATION AND SPECIFICATIONS: -. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well....959.......Distance from foundation.._/.!;�--------Material-----M_18 r4-� '................ r 21— No. of compartments---- �_-------------size....�,..Va.----__.Liquid depth---- 1 --,------.-----Capacity.tine----....... Disposal Field: Distance from nearest Distance from foundaf��f.0--�--.Distance to nearest lot line. ®�. Number of lines-----------------------------------Length of each line---__ ._._.------------___---Width of french---s ---._-_•--------_--••- Type of filter material._:%2±�1�_4JrDepth.of filter ...Total length------/ 4 Seeps it: Distance to nearest well ---- -.0d- .--_-_Distancerom foundation__ .L__�....._..gistance to nearest lot line:..._... Number of pits------ --------Lining material._-_-u,!Lnc. Size: Diameter._- rte...............Depth.... -....__---__----- Cesspool: Distance from nearest well.................Distance.from foundation--------------------Lining material--.-------_--__----------_-- ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity............................gals.' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------..---_-__----.-.-____.-----...':.: ❑ Distance to nearest lot line-------------------------------------------------------..................-_----_-----••-•--- -...------------------------------------ Remodeling and/or repairing (describe)---------------------- -- `- ---..---.------_-�__ �..._�.k+ti�--------.--.-.---.---.--- 'S . t .. --......------------------------------------------------------------------------------------------------------------------------------------------------... --------- 1 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 regulations of the San Joaquin Local Health District. (Signed)------------------� - ----- --� -4 =rte _._�: ----_- -----------------------------------(Owner and/or ontractor) �i -------------- By:.................................=. - 4.. {Title) (Plot plan;showing size of 10t, o ion off sy� in relation to wells, bu ,_etc., can be placed on reverse side). FOR EPARTMENT USE ONLY 117 APPLICATION ACCEPTED B DATE " Z. REVIEWEDBY---------------------------- ---------------------------------------•--------------------------------------------------.-._ DATE----------------------------------------------•------------ BUILDINGPERMIT ISSUED- ---------------------------------------------------------••------------------------------------ DATE----------------------------------------------------------- � Alterationsan or recommendations:--------------------------------------------------------------------------------------------------------------------------......__"..........--••-•----.... ---------------------- ---------------- -------- - ----•---....---------•------------------•------•------------ -- ......................... .. . _ ' --------------- ........... --- ------------------------------W------------- ----------------------------------------------------------------------------------------------- 4 FINAL INSPECTION BY:.- -------------- -- I Date �f=1 .- .-�.- --. SAN JOAQUIN, LOCAL HEALTH DISTRICT y ' 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,California ` Locil,California Manieca,California Trocy,California E6 9 REVISED 8-69 ZM 8-61 ATLAS J