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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .�:' �... -----•------------ --•--- --------------------------- --- F (Complete in Duplicate) Date Issued .. /�� -------------------- -------------------------------- --- This Permit Expires 1 Year From Date Issued 9,p-- lqo13 Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work hereinescri . ' This application is made in com liance with County Ordinance No. 549. r "1`ti 7 00'sE_ Gal c I� _ -✓�. f o."r i/ "r f'; r JOB ADDRESS AND LOCATION..-____cam!D .. ._____.`' t'� . t ----3+ C]? �7� c.9 4 S i.........I---------------------------------------•--....--------.-..-------_---------•-- Owner's Name...... = pm-��------------ - A I � Phone.... Address �.Q_�.... QX _. �_�� tt l � ------- ----------- ------------------ -------------------••------•-----•- °I ---•---•-• I Contractors Name------B—Pthq?--F---Cf1......SF--PTl.0 -F---RS4►C-E—: -4----------I----------------------------- Phone................................... Installation will serve: Residences Apartment House E] Commercial ❑ eTgailer Court ❑ Motel ❑ Other C]Number of living units: J---- Number of bedrooms _- Number of ba"t"hs 101 Lot size ._l_._..______ Water Supply: Public system ❑ Community sys m ❑ Private W Dept i W+ ater Table'. ft. Character of soil to a depth of 3 feet: Sand 6ravel ❑ Sen y Loam enCla Loam ❑ Clay ❑ Adobe Hardpan ew Cons+ruction:f ❑ ❑ j Previous Application Made: [If yes date.__.__- ; °I No { Yes o FHA/V Yes No i •y ®� ❑ N ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: R `,(No septic tank or-cesspool permitted-if public sewer is-available withirK,200 feet:) _T ance om 1 r Septic 5Tl"r&- Not of compartments-_well__________________ izeance from founds}liquid depth__M-----;........Capacity.................. Disposal Field: Distancerfrom nearest wellk_D______Distance from foundation...®_-____._.Distance to nearest lot line... -. p _ E((®Ti N Number of lines_____./...-_-O' '��x(Length of each line_._-loco---_ j{__.Width`of trench------�6....r See a e Pit: Dis#ante It nearest iwell --.- �Qepth of�It.er ma5erial_------_'•2V_ ___.Total length----------I_________------------__ �I ._�— p 9 ype o Ilter mate- Dis#ante from foundation__ __ _.-_•.-___..Dis+ante to nearest lot line_____________ rYs _ '; ❑ Number of pits-'-11 ------------ aterial--------- _,'_..Size: Diameter----......__;-------.Depth....... _________•------____-' .. -- Cess❑ool: Size: Diame+er nearest well---------------- Di pante from foundation____ _______________Lining,material..._..________.________.__.......... Cesspool: -{ (Deth` _ -i--------------Li uicJ Capacity.. al Privy: Distance:Trom nearest well_____ ________ ""'�""+'_.____._.._Distancefrom nearest building ❑ Distance;tb nearest lot lint , ' -m-3 " --------------------------------------------------------------------------------------•---•- --•-••---- --- :---- Remodeling and/or repairing (describer ._.._------------••-----••---•-------II I i ----------i ---•-•.........4;�..... - --- ----- - --------------------------------------------------- - ---------------------•----------------------------------------------------------------------------------•----------- 1------------------- � ---- ---- ------------------ -------- -- .-------••-------•--------•------------------------ ---------------------- i M hereby ceriifyt ave pre d applications and that the work will be done in accordance with 5__anA,Joaquin,County m ordinances, Sf teXaws, rules d/ir`g f +he San Joaquin Local Health District. t . (Signed' --------------•--•- --r-. - - - {Owner and/or Contractor 1 By:..................................... ces, etc.,g-------••-----:-:__c:__:-•------••-----r - n Title _ (Plot plan, showing size of lot, I cation of sys+em In relation-to-wells, buildin be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ __`_ _` ____--- DATE------ REVIEWEDBY--------------------------------------- ---------------------------------------••-------------------------------- ._._ DATE-------------------•- BUILDING-PERMIT,ISSUED;:- =-== y �. - --�r-;D�4TE= - --------------------------- -----= Alterations and/or recommendations:------------------------------------------------------ -; '= ..:- ''` "' l�y......._ ....................................................... �•�---,---------------------------------------------------........................................................................................... ------------------------------------------------------- -- -----'--------------------------------------'.......-•----------------------------------------------------------------------------------------------------- -- -- -• --- -------- •----- -----------•--....------ t FINAL INSP B Date �/:7,// W.3---------------------------------- ; I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street FF zm.t 1 Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-52 ATLAS