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FOR OFFICE�JSE: F M vie APPLICATION FOR SANITATION PERMIT Permit No. ..��.•��...�.�... . ------ ----------- --•--- ------------------------------- (Complete in Duplicate) Date Issued ---------------------------------- ------------------ --- This Permit Expires 1 Ys sr 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 application is made in compliance with County Ordinance No. 549. Ctbje I F`. F, cu we'k) JOB ADDRESS AND LOCATION--+____,7/."? (IV4_y- NFA �5 �2t�i� i= 5TiT770/' --- - --------- --- - - Owner's Name......//e1.0-rS4/.v- ----------0_011 P_x j' Phone------------------------------------ Address.................PLO— .Address_ ----------------- ' tN= Contractor's Name.......: .:.. : Ji9�CR� •- S'Ia�VE, IAC Phone 6 9�' t Installation will serve: Residence ❑- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 21sc2• Y,7/1• Number of living units: -------- Number of bedrooms -------- Number of baths -�-- Lot size ___1---------------------------------------------- Water Supply: Public system ® Community system [1 Private ❑ Depth To Water Table _0 ft. Character of soil to a depth of 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes W No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--/yo -_Distance from foundation----1<!_ ------.Material---_--_l!;'-----a5�!t---------_- 151 No. of compartments--_------�--.----.--Size----c �_�- -_-_ �-�.....Li Liquid de th-__�'-_G.- --_Ca Capacity -'C7c--_--G''�' q P P tY... _ Disposal Field: Distance from nearest Distance from foundation....L�..........Distance to nearest lot line__--_S Number of lines-I ----------------�_____--_-,____._Length of each line------------.3-O-----------Width of trench----....-..4.�./_.00------------- �. * Type of filter maferial.._;Yo.�! ------Depth of filter material........1A-".....Total length-------------------- '-P-------------- Seepage Pit: Distance to nearest well--- _•Distance from foundation-----/-d_1 ... _- .Distance to nearest lot line...... .._�.... ® Number of pits--I....../-----------Lining material---�4�K---------Size. Diameter------ J__"� --.Dept h------------- ........... Cesspool: Distance from nearest well-----------------Distance from foundation-_-.--------------Lining material........................ 'V El Diameter I-------- ------Depth-------------- ------•----------- ------------------Liquid Capacity----------------------------gals. Q Privy: Distance from nearest well ------------------------------------------------Distance from nearest building----_._-•-----.-----------.._.----..---- ' ❑ Distance to nearest lotline-------------------------------------------------------------------------... Remodeling and/or repairing (describe):____, ws__7?..s2-4511J.---.��?---_-- ----��e----- -&S- -- -zlge`� t 1 �1 i --------Com" 4 4,' to - I ) I ----------••-------•---------------- -------------------------------------• ---------------------------------------------------------------------------------------•-------•--•-------•------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statt'e� laws,and rules and regulations of the San Joaquin Local Health District. SCJ (Signed) e '19,_ ---------------(Owner and/or Contractor) o -s..-.: By: ,c -z------ . .�.._ r• -- --- ------------------------------------- [rtle) (Plot pian, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). t Y FOR DEPARTMENT USE ONLY 1N APPLICATION ACCEPTED BY----_-:---- - ._ � �'�-_ --------------- DATE-- -------- -•------------•-- - { REVIEWEDBY-----------k•---'...°---- J- ----- ---• ----------- -------- j ----•----- •-------•------------------------ DATE---------------- ---•-••------------------------------------ BUILDING PERMIT . ISSUED............. -,--k- ------------------------------•------- ------ ------ DATE----•-------------- ------ ---------G--r-p----- - f/ AIterations nj/orecommendations -_------ ------ -----CE- - ----------------------------------------------------------- --------------••------------------------ ----------------------------------------------------------- ti ff FINAL INSPECTION BY:.---L. - ---- ---- �"L�-' -------- 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 Mantecar California Tracy,California ES 4 REVISED 8-59 2M 5.62 ATLAS I