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• r' FOR OFFICE USE: PALM I kfF— W.,vM --..__`..'.....:.-•=............................. ------- - APPLICATION FOR SANITATION PERMIT Permit No....1.7. 3� ------------------•............................... (Complete In Duplicate) ------------------ � This Permit Expires 1 Year From Date Issued Data Issued - .21-3 l 1`0 --0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +fie work he in described. This application is made iri compliance with County Ordinance No. 549. 8'76- 0 . vv-,.. i -' JOB ADDRESS AND LOCATION.''iZE!//? :..RLi._$-0.11!_... __><S/O .__•___ylu, �?`_-_ ._ Owner sNome. Q_/19t L1.�S(!_.__fCsO.QKf....._e0.._..___---!!n___AaW#-F7Tf---------------------------------- Phone/>�.G45'4?je0_____. Address._.. 1y ..................................................... ..................................... ................................... Contractor's Name.._... %?i_/��•_._.r .+e%Q/,�1 . _.4Q/_11ur...1.HG____•................................._..________.._ PhonelOA�,Vj60 7 ....... Installation will serve: Residence9, Apartment House (]Commercial ❑ Trailer Court E]Motel (3Other [3 Number of living units: .-I __- Number of bedrooms _7-. Number of baths __An Lot size -�------- ...................... Water Supph : Public system ❑ Community system ❑ Private R' Depth -to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam e6lay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ t Previous Application Made: (if yes, date ....................} Nod New Construction: Yes ❑ No e• FHA/VA: Yes ❑ No ❑ {'� �- TYPE OF INSTALLATIONTATJD SPECIFICAfIdTISc No septic tank or cesspool arm+tied' if - ublic sewer Is available within 'l00 feet. • s., r l - � � Q Septic ;Tank: Distance -from nearest well_./#V---:.-�Dlstance fr undat+on___.�G___._..__. Material ...... ../�!�Lf�,f+...... ._ Size._ pati (� No of compartments ------------------ .,.Liquid depth.---- .--.-- ty...,I.'CAVj .. ,t ADisposal 1=laid: Distance from nearest well.__I.��'.__._!.Distance from foundation/._�__�-�___.....:D+stance to nearest lot line._.! ...... (v^' - Number of lines_ �_-.__-3—..................ELength of each line._.__f-Q ttt,'...._......Width of trench ------- 2_V.."._..._ --__--__- Type of filter meteriaL_._,Q�GK._..._;Depth of filter material ----- _.L1. ........ Total length_A,____'�... Seepage Pit:. DistNumber of pito es rest well:: __-__Lining mDaterealce from founds ze:nbiameter..,-Distance 'toDneP{�st lot line .:::. .::::::.:: E Cesspool: Distance from nearest well-. ............... Distance from foundation .................... Lining material ..................................... -,� Size: _Diameter----- -----•• ......................... De th __ --- ••- _ --.__. -- Liquid Capacity �� --�gais. z _ P .. _v 9 -P ty-:-- _--.- Privy: Distance from nearest well ........................................... .Distance from nearest building__.___._..____._._-....____.............. ❑ Distance to nearest.lot _ �line------------------------------------------------ - __._.. ��.._..+' }------••- ...Remodeli 9an4/or repairing [ca dri �......-- 0N0MWW'A7_AM7dffl% dt ......................-----------_-_-.-..-_._---.-------•------------------------------------------- -------•-------------•------- ...... .......... 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 'i regulations of the San Joaquin Local Health District. SI nod ....._r:_. �i5x12. /'C-.y��i(J---- %C ' rear and/or Contractor) -------- TBy:_....._---`�-C----•-------------`-•----------------------'---•-----------•---------... lTitlal y a - (Plot plan, showing size of lot, location of system in relation to wells,•buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- �_._.. -. DATE---. "` -------------------- REVIEWEDBY ........ = --____._--_.--- ----------------- ----' DATE ....... = .�--�------------------- BUILDINGPERMIT ISSUED ................!.------------------.._._... _= .... - ...... DATE ........................ .................................... Alterations and/or recommendations:.! ............................. ` I t , ................ : -•------.....------.--------.....------.........__.....-•---....------....._... ......----------------•-•-----. --- .__................•- l. I •------------•-----------------------------•---........---------------------........----.___--_------ ..__..-........... --------------------------- --•---.-- ...........•........................................... F 1 I t I 1 f ...........FINAL INSPECTION Bl:....... ............ ..... .... l' t Date.....- � _ f+ ------.IY-._ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 4' 124 Sycamore Street 205 West 9th Street Stockton, California i Lodi, Californla T Manteca, California Tracy, California E6 9 REVISED 2-69 ?M 6.61 ATLAS