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FOR OFFICE USE: - i APPLICATION FOR SANITATION PERMIT Permit No. ,/..-.-•-- -- t 51 - 1� v 3 ------------------- ----- ------------------------------- ,�„ [Complete in Duplicate} 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 app p nce with County Ordinance No. 549. lication is made in com la� 11 n JOB ADDRESS AND LOCATION.-I.-----.----- �.....M . i` `- ��C�-----.....------------•--------- �•--++ Phone------------••-•-•--•-••..........•. Owner's Name------C.._-••- A: L �r _ ----•--•------------ •----------- -- ------- - -- ------ - ' ! i Address._ ... AN L C ------------------••-•---.....----.• •. ..... ------- = SCJ Contractor s Name...__..O[i!:Nki RX ... ------------- --------•---..-•-- • 1_._...:------. Phone-------•----•-------•---•--------•-Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Cour 4otel ❑ Other ❑ r Number of living units: A---- Number of bedrooms :3-- Number of baths ._ _ Lot size _. . �;E�i�R��'..............•._........ i Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table . . ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Qty.!-F] Adobe❑ �No n ❑ ate____________________) No New Construction: 'Yes N� f FHA/VA: Yes E]Previous Application Made: (if yes;d �( ❑ �. ..TYPE_OF�INSTALLATION>ANI] PECIpICATIONS: -� - �� ------ ---_ (No septic tank or cesspool perrrttted If public sewer is available within 200 feet.) r Septic Tank: Distance froth nearest well-----------------Distance from foundation...___.....____..-_.Material._____.________..-________.____._._...._______-. w # Distance from foundation # ' Capacity... � �11y� No. of compartment's-=--------------- Liquid depth Size - )-.-.__.L u Z'r.Distagce�to nearest lot ije----i-�5 ---- Disposal Field: Distance from Weare twell________--Dista EXI[§Tr r4 G- Number of lines....- ---------- t!A----Length of each I$ /D '° -.Wfuii.pf trench.__._.. f a ADP Type of filter raterial.-R. G_rl._�_Depth of filter aterial------1 _____._•-_Toil lJnngth-----��-�p----y=---------------••-- q Seepage Pit: Distance to nearest.well_____________________Disfance from foundation.___......__._____.Dista ice to nearest lot line___._______.:.... ❑ Number of pits.__.__ - Lorin material_ *._ ---- --.Size: Diameter____...._°--; -----,.Depth--.--------""------------- i ti- Lining l e Cesspool: Distance from nearest well.................�ai'tance mfounda+ion_ ________-_______-.Linang material__-._________._._.__....-___..._..__. ❑ Size: Diameter--------- -----------•- Depth ------_--- ••Liquid Capacity-------•--------------------gals. e 0reelrr�i w+A 1 = Privy: Distance from nearest well___ ---.`--------------------Distance from nearest 6uilding------------------------------------------ Privy: to nearest'lot line------------------e5- -------- ---------------.... .. ---- -"----•- ....., t 11%, Remodeling and/or repairing (describe)-------------- --- --- ----•-••--------• -�------------------------------------------------- i I ---------------------- ----------••----------- •=--- --•---•------------.---------------------------- -----------•--- --•-----•------• ------------------------ 1 ------•------------- ---------- -------------------------•-------- 1 1 -------• -------------_---•-ti------------------ -----•-----1-�-------------------------------•------------------- .P. ---- -------------•--- I hereby certify that I haf;andd e �epared this application and that the work *ill be done in aeeortlance with San Joaquin County ordinances, a s, and r r' ulatio of the San Joaquin Local Health District. l cia�� 4nV Si Wed ------------ ' . her en r on ac( g ).--- .. -(-- ---- --- ,�'7 E By;.............. -•---`-- ----- - - ---------- ----------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plreeJd n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------------------------------------•----------•------.... DATE `I_ - � REVIEWED BY------------------------•--y-- -- } -- -- --- --- ------------------•------- DATE -- - - -- -- -- BUILDING PERMIT ISSUED.... ----------------••-•--------- ----- DATE----------------------------------------------------------- BUILDING and/or recommendations:--- ""---------•------------• ---•---- ---------------------------------------------------------- ___. ._.. ------------------------------------------ , S _ ________________________________•--_.____ .. -. ____._.-______..._.____---___.__---___--.-____.___.___.-_-_ .. _ Mw� ______________________________________ _ -n! _ __________________________________________________________ ___ _ ____ ___ --.............................................. 1` �`.��,.N----•--------.-------••-- --_--------- - - _ ___ __ ______ _ _ �J FINAL INSPEC Date---- -- --. ----•--------------_--------- ' SAN-JOAQUIN LOCAL HEALTH DISTRICT 49 130 South American Street �. 300 West Oak Smoot ---� t44 Sycamore Street 105 Wept 91h Strut Stockton,California Lod[,Cai epn!!S r.. Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS r Ali _