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I•UK Ut-HUL USE: - -------------------------------------------------------- --------------------------.__.---.._.._-..___.____.___- APPLICATION FOR SANITATION PERMIT Permit NO. .....!_.;__ . �,� (Complete in Duplicate) .P-� Date Issued --- -------- -�� This Permit ExIres 1 Year From Date Issue ApplitationRis hereby.,�made, orthe4Sen Joaquin.,L-ocalTHealfh Dist.r-ic't for,.e. ermitJ-64 consf�uct-and ristall the work herein described. This application is made' in compliance with County Ordinance No. 549. JOB ADDRESS ANDwLOCATIONh_ Owner's Name-•--------- 1 rLJ m ,«-► �s.w 'r„iY �="p��b� �� 1r1L74a� A � aw - Address.---•--... -� �� 0 ,? + dpi, _ ------------- -�-�__ _� - -- - --------------------------------•----------------------------------- Contractor's Name........... !''�11 �r ' -----------••-----------------••--------------------- --- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial F1 Trailer Court El Motel ❑ iOther ❑ Number of living units: ±: Number of bedrooms _ __ Number of baths _f_.... Lot size ._.� .__��'`'_fti?- --•_.•--___-__ �` Water Supply. Public system ❑ Communitysystem Private De th t Water Table Y ❑ � p �Q. ft. Character of soil to a d'.+h of'3 feet:,*Sandp p Gravel ❑ Sandy dy Loam Clay Loam ❑ Clay [] Adobe❑ Hardpan [] Previous Application Made: (If yes,date__.__�----------- No 0 New Construction: Yes �No ❑ FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND PSPECIFICATIONS: ' (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic ank: Distance from nearest well____ ____Distance from foundation__..la___..__.MatQrial_--��r~~�� No. of compartments-------' --.--------$ize__ - •_-Liquid/dyepth--- -----------------Capacity__.,I; QQ_- Disposal Field: Distance from nearest well�49-----Distance from foundation___ ---------Distance to nearest lot line...L ----------- i . Number of lines___-_ ----------------- -. Length of-each line____: ' ' .Widt#i of?trenchl -s�� -W r Type of filter matenal._._ RV _ Depth of filter material.-� X-----------Total length g Seepage Pit: Distance to*nearest well. _ -_— _.__Dishnce from founds#on. ___._ _.:__ ce fi nearest lot line_________________ p _ice g �..Oi - "- � �...Depth--------------------------------- Cesspool: ---------------------•------•--- f Cess ool: Distance.:frbtn n aresfrW'&I ...... .___-_Distance from foundation _ ' ❑ Number�of its s Lini material.---- _ �alS.izet iometer LiningTmaterial_______________•.--_---------------- 0 --•---...--- •-•_-• Privy❑ DI s#anDcefromr rrearet well'_ �eph_____ _ _ __ are9t Liquid aci `-- �„�„� tY---•------------------------gals• �" Distance from n ildin I r g 3 ----... ❑ Distancetfo nearest lot line__ _ .. Remodeling and/or repairing ( escnbe :----- 117-----� 'I' � p..---f!'I/f ....... 'lL -------------- - --------- ' �P1-- -�_..i0$S--------B_&C f:7 ��._--$ I 1 �. ` -----------------------------------•------------------------ ... ------------x 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 location and are ulations of the San Joaquin Local Health District. r (Signed)-- [ --------•----------------�---•------------------------•---•----- -----------•�----�------{Owner and/or Contractor) By: - ----------- ---�_--------------•--•-------------- - - -- - --- --- --------(Title)---------- -- ----------------- (Plot plan, showing size of lo of sy t m in relation to wells, buildings, etc., can be placed on ri�"everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ►z - <:.------------ _ DATE-__!9' r�^=" REVIEWED BY----------_------- =:_ _.,.: _ ..= _ . , ` t`�p DATE .-------•---- BUILDING PERMIT ISSUED.-----------•-----"------_ - ----- --------•- ------------•----------------------�--------------------------•-------.._. DAZE..-------------•---•------- Alterations and/or recommendations:---------------_-------_----------- ---------------------------------------------------------------------_- -------- ---------------------------------•--------------------------•--•--------.--•------•-----------•---•---------•--•-------------•-------- ------------..................... •--------------------------•---..-'.............................1-f----------------- ------------------- -----------------------•--..-..----•---------------- FINAL INSPECTION Y,. Date �.--_..------ -�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 134 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California � .� E6 9 REVISED 8-59 7M 8-61 ATLAS