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FOR OFFICE USE: --- - - APPLICATION FOR SANITATION PERMIT Permit No.......1'-�_q.�-.7 ...--. --... I -- --------- ------- --- ------- � Dote Issued --- - :...(.o L ... ._. -....- -... This Permit Expires 1 Year FronMate Issued Application -is hereby made to the' San Joaquin Local Health 'District f o.r a � rrrfit-to construct and install the work herein described. This applicatlo'n irWWde-in complinwwitti-C-M ty Orninan`-ce-"KoI49. Il ii / n n,� J08 ADDRESS AND LOCATkC i�74`",r -/�14. �'7�L_...... !-►!/li�-� l `".F-71 WS_....._.MAR--J-�-------- ------ ------ ........ 1--- - ------- ------ Phone.-- ------.......•.---------------- Owner's Name .............. Address-------..--_--- o ..... A AIRF---------- .. Contractor's Name- ly *,__ LLa.E.P.--------- - ./q .!+rE� _------------ I--•-•-------------- Phone --------------_-------.......... : Installation will serve: Residence asApartment House ❑ Commercial ❑ Trailer Cort ❑ Motel ❑ Other ❑ Number of living units: __I-1 Numbevf bedrooms 3__. Number of baths ,�- Lot size ____L.,�-.x----�-�-----••---- •-------- Water Supply: Public system ❑��ommunity s stem ❑ Private Depth o Water Table f71-_ ft. ` Character of soil to a depth of 3 fbet: Sand E911 Gravel ❑ Sandy Loam Clay Loam! [j Clay ❑ Adobe ❑ Hardpan ❑ �\ Previous Application Made: (If yes date._. i....y No ❑ New Construction: Yes © No ❑ FHA/VA: Yes ❑ No C or!( ---IYPE+-OF-INSTALLATION AND¢ 1PECIFICATIONS: (No septic tank or cesspo Upermitted if public sewer is available within 200 feet.) Se tic k: Distance from nearest well ...JTQk a rom*f5undation...._/ .. ----Mat ial_ �7` ........ No. of compartments-.-----r� Sii' ..X y__!�._.. Liquid depth-_---- -----.-_---____-. C� amp C Disposal Field: t Distance from nearest well. -.,50 ins, 1 i's, e0 i3�fr6'n�»foundation__...1V-- --__.Distance to nearest lot line ----- . Number•of lirie--------- Length of each ane______._ ....Width of trench- .��.��_.r- - /4D� 1 i T ype of filter rmaterial...._�.G�...Depth of filter ateriat.---- 1.25 --___..__.Total length -------- _______�tt%_---_-._-_- 44 k Seepage Pit: Distance to nearest well_...................Distance from flundation_.___.-.____._....Distance to nearest lot line ...___-..-.-_. -- ❑ 'Number of pits------------- Lining materiel------ Size: Diameter---.............. ,._Depth ----•--.------.---.............._ Cesspool: Distance from I earest well.................Distance from foundation _...... .__.....___.Lining material ........ .--------- .--_--_-.-_-____ ❑ Size: Diameter- R-- ....... ....................... Depth ----- ...... ------ -- ---- --- -Liquid Capacity -----_--_---------...... gals . Privy: Distance from ................... . .....Distance from nearest building__. ------ .._--_.---_--.................. ❑ Distance to nea st 1ot Gne-- ------------ ••- •--_--•---•-•----------- -I-_-_-------------...+ ....... _----------- _............ • ...------. -- --- .... I Remodeling and/o+ repairing (describe):. ---------- ----------- ------- ................................. .........................--....... • -............................... .......... �1r-y%'i'� 1 a rll ................................ -------------- ........ �, 2 ------•-•------y---__'- -------------- -----....--- I hereby certify that I have !rep with San Joaquin County ared this application a �d that the work will be don eiin accordance ordinances, State &S, and rules and regulations of the San Joaquin Local Health Disfrict. .................................. .. ...(Own and/or Contractor) ...(Owner c (Signed) -- .. - ---tom`=c•<-- .. ._ er---------------_--------------------------------- .._•••...........---•-•.....{r la) - (Plot plan, showing size of lot, locefion of system in relation to wells, buildings, etc., can b1 placed on reverse side}. 1 _ _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----T. h..-'--------------_-.------------------------------------------------ ;ATE--....... .....�.- REVIEWEDBY, ....---_------------ ------- .... .--• DATE ...... ................................... ---'---•------ -...- BUILDING.PERMITJSSU.ED.--..- ` rt -------------- Alteratoi and%oriecommendaTions:.............j...,-- ....................................................----- -- N.K.._ . © .............................. ..-----------Cc l ----------------- -------- --------- - --------- .............. ---------------- f j FINAL INSPECTiO Date_. ....!-/-'t __617�� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 124 Sycamore Street 205 Weft 91h Street Stockton, Californlo I Lodi, Callfornia Manteca, California Tracy, California ES 9 REVISED a-89 2M 5-62 ATLAS V ' L.