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T FOR OFFICE USE. -------------------------------------_------------- `r APPLICATION FOR SANITATION PERMITPermit No. --------------- ----------------------------------------- (Complete in Duplicate) Date Issued !_ _..:3 _r �- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work borpin described. This application is made in compliance with County Ordinance No. V+1 JOB ADDRESS AN�D/LOCATION�--�-�.Qk5�----- Qin •.okra Owner's Name------- ----------- --- -------------------------•------------- ----------------_................. Address.---- ? � P.. 4� ------------I'—0M9G en A f t.�:_OnI.............................. Contractor's Name__ 1g `:IE f�p =------teal�'V� --------------------" ------------ Installation will serve. Residence Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . r Number of 1iving units-4 Num-be of bedrooms _______ umber o bafhs __ ____ Lot size ._. ' `��=�----------•-•-------- s Water Supply: Public EsystemB—Community syst m Private Depth ro Water Table !.�__ ft. Character of soil to a depth of 3 feet: Sand ravel Sandy Loam. lay Loam ❑ lay ❑ Adobe❑ Hardpan ❑ Previous Application Made' llf yes,date-------------------1 No [ /New Construction: Yes No ❑ FHA/VA: Yes C] No TYPE 7 OF INSTALLATION AND SPECIFICATIONS- �_ i _ _- . - - . - - - -- (No septic tank or cesspool permitted Hed ifpuTblic s wr is availablewithin 200 feet.) Septic T k: Distance from nearest welL_�`. _____Dis#ante from foundation___ Mae ial____Cf�At. } 7� ------- l No. of compartments _. -Siie _.. - ---- Li uid depth_______ ________________Capacity____ ... Disposal Field: Distance from rleares#well_-- ___._____._Len th of each line______ ' Distance to nearest lot line----,-'7___-___. *"'�'-'-----.--Distance from foundation '-Number-of"lines----.._' w g _._ _ Width of trench----- --!-------------------- ---------------------- Type of filter matenail...R_V_C_�.__Depth of filter material.. "°/`_ ________._.Total length---------------I-.----__-_-•-_-_____..__ Seepage Pit: Distance to nearest well_____________________Distance from fo''ndation �.. h Distance to nearest lot line___...._._____._ ❑ } . . P Lining matstanlce from {o ; Size: Dizmeter Depth OJ Number f its_________,_ Cesspool: �Da�nfrom 'neare t well---------------__Dr �ndation �_--.Lining material___.._._...________....___.________. ,.... ----- Depth--•--- "Distan { m Capacity gals. -y 1 1-Size: D�amefe�------- • ---------------------•- ii - -- .-LiquidP ty----•--...-------------•---- Privy: Distance from nearest well-__.__:___.___-__"-�___________________-_--L nearest building--_-_______________---_-----_-.----------- ❑ Distance to nearest lot line-----------•---------------------------------J--•------ - ...,.....------------ 1. f 11: Remodeling and/'or repairing [describe(:_ 1_1_1 --- ----------------- ----- ----------------•-- ----1-•- �, ------------•----------- ------------------•----------•----•-----(--•------•----------------- "---------- ------- --------- -- ------- - -- Zu--===-------_- _ -------- ------ --"---- ------------� � n' I .��..,o.-- hereby certify that I have prepared this application and tha0the work will be d.� in accordance with San Joaquin County ordinances, State lads, and rules)amre7gula ons of the San Joaq6tn Local Healtk District. IJ L (Signed,_,, `t't/ = --------------------- ---------------------- _. B t.. ------ ----------------------------- ----------- --------- = (T#le)------------------------------------- --------------- ----------------- �- (Plot plan,, showing size of lot, location of system in relation to wells, buildings, etc#;can be placed on reverse side). FOR DEPARTMENT USEfONLY ------------- APPLICATION ACCEPTED BY----------Mto------------------------- -------------- -------•------------•--- DATE----- � REVIEWEDBY--------------------------------------------- --------------------------------------------------------I........................ DATE................-------------------------------------------- BUILDING=PERMIT-ISSUED----------------------------------- -_-_ DATEm �- -==- --------------------••-----.-.------------- Alterations and/or recommendations----------------- -�- - ...: _: - =-------- P,------------------------------------------------------ ---------------------------------- I------------------••------------------ --------------------- -----•-------------------------------•---------------------------------- •------------"---------------•-------------------------------------------------------- ---------------------------------------------------- FINAL INSPEC71 - _ ___R_.. __ __ ---- ---- Date........✓- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strut 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 2M 5-6Z ATLAS +`"