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F R OFFIC �kL � •_ _�.� JJ APPLICATION FOR SANITATION PERMIT Permit No. ...,1 .�_5 ----------- ---- ------ (Complete in Duplicate -------- -------- ---- Date Issued .-Z --- -- --- --�-�--- This Permit Expires 1 Year From pate Issued Application is hereby made to the Stn Joaquin Local Health District for a permit to construct and install the work herein. This application is made in compliance with County Ordinance No. 549. .described. JOB ADDRESS AND LOCATION.— Owner's OCATION.Owner's Name-------------- �-96;11(plzlc).__..Address C Lf ---- ................ ---•---•1 -- ------- — ------------••----.................................. Contractor's Name----- 1�1 Phone -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms --3-'Number of baths __ -Lot size ..._... . �_ 1 Water Supply: Public system Community system ❑ Private ❑ Depth To Water TableJ_V_"ft_ Character of sail to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Gay Loam Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date------------------_) No New Construction: Yes ❑ No B--'_FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: T"' 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTank: Distance from nearest well-------- -_-_-_Distance from foundation.______ __.Material----.-_-------_._ .............................. � ElNo. of compartments----•------•--------------Size Liquid depth capacity P Ca aci _----••-----•-•------ Disposal Fiel Distance from nearest we1Wk WW4bistance from foundation./C-�------..Width of trench---------Distance to nearest lot line-._� N -_- Number of lines........ ''ffes. •---�---------- ---�----Length of each line----------��---•• �T-..-------- Type of filter material.-. .Q- --------Depth of filter material--_-_�e--„-...-Total length-----------,S..Q.'------------------- Seepage Pit: Distance to nearest well/Il0/ t- Distance from foundation---6?_'_........Distance to nearest lot line.__. ,l Number of pits-----/--------------Lining material, . -.Size: Diameter---- --------Depth------- ------- •-•• R•�`i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------- - Size: Diameter-------------------------- ------Depth-------•-------------•----------------- -----------Liquid Capacity -----------------gals. -- Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building ❑ Distance to nearest lot line------.----•-------•----------------------- Remodeling and/or repairing (describe):-----�l111z____. W1/,Y---T X147Z_V_6--- C YrSTC/97_ .....•------------------------- -------------------------------------------------------------------•------•-----------•--------------------- --------------•-•--------------------------------------------•----•--•----------•------------------------ •-----••------•--••-------------------•--------------- " -------•-----------------------------•-------- ---------••---------------------------------------- •------------------••--------••-------------• -----------------------•----•------------------------------------------ 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 rules and regulations of the San Joaquin Local Health District. {Signed} ------, .� D� ------•---1�vHR„,q __ BY= l Chir------••---• - N. r {Title) caner and/or Contractor (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - -----t: - ------------------------- ' DATE...BY .._ (q --- ..... ---------------- ----- DATE BUILDING PERMIT ISSUED______ _______________•- ---------------•----------------�------------------••----------------------- DATE-----------------------_------------ Alterations and/or recom '-------------••------- - � end'ations:-------�------�--- ---- _ --------------------------------------- Al tit -- --------- ----- FINAL INSPECTION BY:. .__._ ._-< - -•---__ ----------- 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 ES 9 REVISED B-59 2M 5-62 ATLAS c�=* �"'•�'-