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i 1 � FOR OFFICE USE: t� I - --- G- ------------- J APPLICATION FOR SANITATION PERMIT Psrmit No. ... ..,�o l - ------------------ � (Complete in Duplicate) Cn-l----- --------- ��'W`� e Issued .. ---.--- Dat This Permit Expires 1 Year From Date Issued -r�.�-- -• i Application is hereby made to the Sen 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. JOB ADDRESS AND LOCATION.....:.:...../--- --- ---(, -_ '° / GLAatr__.- S /�,c/f c� 11) ••----------------•--•------- ...--•--------------•--•---------------••.... Owner's Name------_---------- + _ .; `f f e �J1 -VO e3� - 1 ) -- - --•----------- --•-------------------- ------------------------••---•-------------- Phone Address........................ y' �`I/I Cc.e�- ------• .... ... ...... .............. ------ Name----------- ----5 � = .................--- •-••----------- c� p ...�.� . .. c Installation will serve: Residence 21Apartment House ❑ Commercial Trailer Court i' ❑ ❑ Motel ❑ Other ❑ Number of livingI i units: [ Number of bedrooms t- -_ Number of baths .j..-. Lot size _..-.,5`'f--- .-_ ..Z`?-["------............ Water Supply: Public system ❑ Community system ❑ Private Q' Depth ro Water Table -76- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobet Hardpan ❑ I Previous Application Made: {If yes,date--------------------) No P6 New Construction: Yes No ❑ FHA/VA: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well_.- -_Distan e�from foundation---�G... .--.Material------------ --------------- --------------------- U No. of compartments- --- ---2-----------Size.-.- rr��'-------- ---Liquid depth------96 aci 7s - P tY-...�-- Disposal Field: Distance from nearesfi well�6�-_-.--Distance from foundation ~' / f�� Distance to nearest lot line..... ......... \ Number of lines----- ---- -------- Length of each line---------- _--.-_- Width of trench-.--%�__ Fr--------- - ..................... Type of filter material_.--.-._-. -- K'- -Depth of filter material.,11-._------_--Total length...-_---. -------------- Seepage Seepage Pit: Distance to nearest well---- D/- c--�---- m --/ ....--.Distance to nearest lot lwine- � Number of Pits--...... _--.- Lining material.. -_--_`F-_--- ------Size: Diameter-----_ 3 DePth - Zv-_' --- .......... Cesspool: -..._. Cesspool: Distance from..nearest well_--------------Distance from foundation-_._._i----------- material-------------_------ - ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity ------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building 13 Distance to nearest lot line_---.-_--- _.--_----_ Remodelin and/or repairing descriLz 3 t ! = ------••--------••-------•------ ------ F r, f ----•- ------ ---- • ---- -•-- - 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 and regulations of the San Joaquin Local Health District. f -' -. .0 (Signed)---- j-------------------- .-------- �; ---------------- --------------------(Owner and/or Contractor) r• -� �� E' �• = �� = -f -------------- (Title) t. -� -� s .---/--- (Plot plan, showing size of lot, location f system in relation to wells; buildings, etc., can be placed on reverse side). , t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y_ /✓'_�� DATEC - 3' '..: -•-----•---- REVIEWED BY ---•------------ ----------- ------- ----•--------•------------- DATE BUILDING PERMIT ISSUED------------------------------------------- ------------------ --,-----•------(- - --�,._.r. DA- TE Alterations and/or recommendations:--- --- ---------------« # �-� ._.. ` I # � ---1- ------------ -------------- - �- -- ^�� -----�/f ------- ----------------- ------------ -- -•l7 - - l-•--=--�--3- ----L---F �------------------- ---- � - .•c.-.i,�" --------------- � i/ 1 Y`-r --�'- �-�, e�-�-�-�" a.-�--an•----��---- fie•-�-".:��-��.�---�1;�--t�--�---------•-•�-- �f FINAL INSPECTION BY:. ...'C- .---- Date------------------------- - - ---- . t 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,California Tracyr Coiifornia ES 9 REVISED 8-59 2M 5-62 ATLAS