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FOR OFFICE USE: -------------- ------------------ ------------- / - APPLICATION FOR SANITATION PERMIT Permit No. ..!-_ .__. ��.-1/Q' (Complete in Duplicate) Z i Date Issued ___.�.--- ----------------------------------------- This Permit Expires 1 Year From Date � _Issued yf ^ 41 o r(' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here' described. This ap lication is made in compliance- th.County Ordinance No. 549. MA1�rTECA JOB ADDRESS AND LOC ATk Nt p rAA r n 1-` +--ALS lUQ rQNF?-n� _ .� Owner's Name___BEiq_ �rTo.----•-du.T - ----------- -- �S-F,H_0. . -----•--- Phone--1-8'_3.: Q_T.q__ Address-----•R�-E---._��T_.... ..BGX----2-7-T---- 1 t `T - --------- --- Contractor's NameANT1 �; Psl __- _.._2R: _ L:w----------------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Cimmercial ❑ Trailer Court [IMotel C] Other ori 1�e�T�+. - ---- Number of living units: __I__-_ Number of bedrooms _�hlumber of baths .-_-.... Lot size ....... ------------ Water Supply: Public system ❑ Community system ❑ Pri ate Depth TO Water Table _._ ft. Character of soil to a depth of 3 feet: Sand [/'Gravel ❑ Sandy Loam gT'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ , Previous Application Made: (If yes,date--------------------) No New Construction: Yes L8" No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - k (No septic tank or cesspool permitted if pubkic sewer is available within 200 feet.) ,..,,.,,r at 1XISeptic T Distance from nearest well- -- . -- - r}�•� m foundation--------------------Material---------.--.-.------.-- ---------_-_.--__------- L No. of compartments � �/V e --------------Liquid depth--------------------------Capacity-------------.-----•-- Disposal field: Distance from nearest well--- Distance from foundation... _ 4 Q-.------Distance to nearest lot line---- 'F_X 'x-1146 Number of lines-_-_---.._/ _ -------_----_ ---_•Length of each line-...... _I ........Width of french------- .�.- Abi7 Type of filter material.-RO-C--K---.Depth of filter materiaf_- -----Total length------_-.f p0--------------------- Seepage Pit: Distance to nearest well----_-- --- .------_Distance from foundation---.................Distance to nearest lot line-----.--.----_-_- ❑ FNumber'of' is_'•.""..'.•","L`isiiiig material-----------------------5iz Diameter------------------.....'Depth-------•------------------------- ❑ Distance from st well- 'Distance _,n------y----------.Lining material------------------------------------- Elize D ameter_n t het"j-U. _ ____--_..Depth, from foundat1a4_et--------------Liquid Capacity_._._----_----.-..------:gals. Privy: Distance�fror`�r+ nearest waR----------:--- ---- --------------DistanEe-from nearest building---------------•--------_--•.-------•---- ❑ Distance to nearest lot line--------------- ------ I---- ------------------ ------•- --------------------- Remodeling and:/or repairing (describe):-------------------------- -•-•------ "' .... ---------------------------I---------------------•--------------------------------. -------- I------------- ------------••------- ------•--- -------------------_--------------------------------•--------- ---- z_.--__ ... –.-.� ..I-- ------------ -----------------------------•--•------------------------------------------------ I ` tom -- - -------- - - ----------- -------- --•--- ------ I hereby ce that I have prepared this application and that t e tk will be done in accordance with San Joaquin Coun ordinances, Sta s an a regul tions of the San Joaquin Local Health District. � t (Signed?------- -----------_-- ------- ---- - -- ---------------------- ---------- - v---------------------------------------•---(Owner and/or Contractorl , By:........................---------- ----------------------------------•....... - ---- --- -- (tike}-..... (Plot plan, showing size of lot, location.of;system tin relation to wells, buildingsi.etc., can be placed on reverse side). `aA �'�PFOR^DEPARTMENT USE ONL'1' APPLICATION ACCEPTED BY--------- 1 a r ' k --`---- ------------------------------•--•-----------•------------ DATE------AQP-�`A�— REVIEWEDBY---------------- # -------------------- ------------------------------------------------------------ DATE---------------------------------------------••------------- BUILDING PERMIT•ISSUED:_.:_:-_: . ��.:_ _-_ _...." — -` -" -=— �'".'..r --�_--•DATE: :- ------ _...,.... ..,�.�._ _ .... _ . ,. _ �� ._. __ �.Y-_____ Alterations and/or rrecommendations-� -----i , 3 -ij ----- ---------------------------------•---------------------------- , ------ ------------------------- - ---- ----- s"'="�_f"I* ? -A-----------_- ---- • i ------------------------------------------------ -- --------------------------- ••------------------- FINAL, INSPECT! .---- ------- Date -. �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .r ES 9 REVISED 8-59 2M 5-62 ATLAS I