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FOR OFFICE USE: _ . - - - ---- .�. .. -------------- ----------------------------------------- APPLICATION FOR SANITATION PERMIT r Permit No. _ ... (Complete in Duplicate) a3 —0?0 J�u 1., ] ------- ------------- - -------------------- ----------- - ------=-------- � Date issued ---- --•-- This Permit Expires 1 Year From Date Issued ; 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 compliance with County Ordinance No. 549. v�'1 DlE^ t JOB ADDRESS AND LOCATION-----, t71_�'a •--- i'! [_�A�-G_.. ----Q ------ CjiQN. i� � --• -- Phone.. ' Owners Name---------------Y-1C111'F. .,?------ Address-_....--�1EF_=_ j••--• 1333X------- �� ------ Q one -:- $ L - Ph c } ` Contractor s Name_ _- Tpf �-I- —��-r: � Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ,❑ Motel Other Number of living units. _ Number of bedrooms _-__.--_ Number f baths _ --..__ Lot size __-- ---••••----------- w+1)' p I 1-��-- ft. 'S 064 Water Supply: Public syste ❑ ' Community system ❑ Private [Depth to Water Ta e Adobe Hardpan Character of soil to a depth of 3;feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made: (f)es,date-4 _.- -----) No New Construction: Yes�No ❑ FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t t MaArerI-. ®-& ��. �— Septic Tank: Distance from nearest well.--4----------Dista e from foundation---10 ----Ca acit 21 a No. of com p0_7 menfs_`- Z .----- �Q x_-�- Liquid depth-_-__ -.- P Y Sixe _ _ • [7 foun do .___./_47......_.Distance to nearest lot line------------ Disposal Field: IDVlumber`of.om I nesearest well DLenath of ro a p s Length eac line . -fit- _.Width of trench..---- ---.-- F ti --- j_.- -3333 Type of filter; material._.® ----Depth of filter material------ ------------Total length----------5 = `� ` r Seepage Pit: Distance to nearest well-_/06---e----Distance from founds i�/p --••.Dist nce o nearest lot �._-Lining materia[�_R©K_-__.Size: Diamete4txffA-_------.Depth----.- -- -•-------•-•--- �'' Number of!p�its._,� [ Cesspool. Distance f!o1n nearest well-----------------Distangle from foundati� Lining 4materiSl_-.----.._,-__-.-----.-.--_--___-.--. ❑ De the = r` -"'l:quid CaPac.Ty---•-----• gals. Size: Diameter------------------------------- P r Privy: Dis tanc�e:fr)o ..nearest well-------------- -------Distance from nearest building.�--------------------------------------- I ❑ Distanceto from lot line- - -----------------------------------•- 1 d _ Remodeling a re ai�ng,[ cribef:---hPPR.<- --•.-- ----- - f i 1 11#Y? 1 T"- � ---- �1 � �U.55Z ------J�1 _.-FQ-J\ �a fz ---- .Q.---�----Fes'----0 .---- �. - Ufip 1n 7 ------1-�f_M-. "TT I 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. -----------------------------------------(Owner and/or Contractor) (Signed) -- -- ------•------------------ J - ----------- ---------------(Title)--------•--------- ---------- -- ---- i (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse side). [ FOR DEPARTMENT USE ONLY •�r"=,�k r�ls, .,.arc. i -_ �_� DAT APPLICAON .ACCEPED.BY.- DATE -------- ----- ------- REVIEWEDBY "'---------------------- ------- --------• ------------ --- --- BUILDING PERMIT ISSUED------------_;------------- ------------ DATE ' ------------------------------------------ Alterations and/or recommend'at'ons:---------------------------- -----• ----------•----- •- ---------••------- -----•--- '. --------,�,,.M--•---r-o-------66ND-----•------•I KR-g -----•-•-------------------------------- ------ -----•-- ----- - -•.-� R R�_�h -------------------------•- --3--333........................•---_-_---• ------ -- • - ---- --- ------- FINAL INSPE� Date /4�1 `- t ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wt Oak Street 144 Sycamore Serol 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV15ED 8-59 2M 5-62 ATLAS