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T FOR OFFICE USE- ` ----------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. -• --- ------- � j 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 descried. This application is made in compliance with County OA rrdinance No. 5499. n JOB ADDRESS AND LOCATION------L.57_-.[ll.-------I A -r` ..... w...`---`-----------J�IAUIE 4---------_---------•--- Owner's Name---•-- -�.Icr7T- �K- Adt� -A&�=-.---�a'------- PhoneTj1-".3.-3.1._ ._. [ -TIM-6- Address................ .._ Contractor's Name_____{ �N ECA 5EPXfC ..__ -------•••-----•---••••----••-•--- Phone--------_---------_-_--------- I Installation will serve: -Residence ❑ Apartment House [I Commercial oeTiailer Court ❑ Motel ❑ Other ❑ .� s— ^mbe`'r'4 aths .p_.. Lot size ......fRX-- -----------•---------•---••------ Number of living units: .._____. Number of bedroorras�.__ NuC- C tem . Communi :s' s 'On-,*O, T Private$ . VDepth TO Water Table _15. ft. Water Supply: Public,system ❑ #Y Y Character of soil to a depth of 3 feet: Sand �...-Gea ' 10-i St' -dy Loam Clay Loam ❑ ' Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote__.-__.__.___.--.._} No New Construction: Yes �o [I FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND $PECFiCATIONS: r �,�r� (No septic tank or cesspool peAAFM-6d�if public sewer is available within 200 feet.) <1.# rr (.�-- ----------------- Septic nk: Distance from nearest welL._y7__ :_..Distance from fou ndatio ___� _-_____..Mat�l I______ 1� ---_Ca aci f 4ae---•---- No. of compartmersts___. ------•-------5ize_'a_.. - --- = 'LI �uid depth__- .- --- p tY { /0__...__.Distance to nearest lot_line_�.` ^-- Disposal iald: Distance from nearest well-_ Q_..-Distance from foundatio ._____ y 1* 2r— Number of lines-----�--�------- ---------•---Length of each line------- -�-------------Wid+h ,of trench.------ .__P..----•---.... r �i /f Total length Type of filter material._RL1_C-�;---Depth of filter material_.I. _ / :2-3 - Seepage Pit: Distance to nearestrell______________________Distance from foun.dation'n�----------._._.__,Distance to nearest lot line................ 4 ❑ Number of pits-_. ...... --- g ------ nin material....__.. ,µms-�_-:.-Size: Diameter------------------------Depth--------------------------------- Li� ,,. t Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining � material--------------------------------. _._ -----------Liquid Ca a-c. ----------------------------gals.. Size: Diameter-----�-----•-----------•------------ --- i❑ Privy: Distance from nearest-well __ Distance from nearest building__ _.-_____________..------------........ ❑ Distance to nearest lot line- = ----------------------•---------------------------•--------.---------.------•--•---•-•-----•- ------- Remodeling and/or re pairing,(descrr„ib,ej- --------------- ------- ------•-----------------------------------------•----- ='”'�--. f-•--••----••------ -f I ' '--------------•--------•-••------------...----•---------------•-----•--------•----•------------------=--- - -----------•----•-----•--------•----------- ---- -- ---- .---- --- --------- -----'-----San----'---quin_.___---- ty hereby rti +hat 1 ev re ar d #hi aplication and that the work will be done in accordance withl San Joaquin County ordinances, S, aws; an rues a T gulat on of San Joaquin Local Health District. ' f 1 +9 Owner and/or Contractor) -- �j � { (Signed)__---- / G ' :i1' ----- - ----------------------------------------------------_---------.(Title)--------------------------------------------- ----------:_' (Plot plan, showing size of lot, loca do o system to relation-toeweAs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t DATE_.- _ APPLICATION ACCEPTED B _ "-'- --`--------------------- -------------------------------- ---•-•- ---.------------- .�. •------------ DATE--- ------------------•-••------------------•------------- REVIEWED13Y_.. ._: -------------------------•------------ BUILDING.,PER_MIT I.S-S.U,ED—. .__--- Alterations and%or recommen ations: ----;---•--------------- ------------------- = -= --------------- -:••- -----------------'_ -�f '. ---•---' ---- 4. '� 5 --------------------------- ------- ;_`--._=�`�---•-----------• ----- ------•--------••--------------- t�!_ra :'�4------------•----•---...-----•---•------••-------•-------•--------=---------- -• --------- , ----- FINAL INSPECTI Date-------- - _��rY_J_ ---•---•--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weil Oak Sweet 124 Sycamore Street 205 west 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-62 ATLAS `