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FOR OFFICE USE: ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.-------------------------------------- ___....._. -------------------- -------------------------- ------ (Complete in Duplicate) Date Issued ---------- ---- ----- --------- "--_---_.............................................._ This Permit Expires 1 Year From Date Issued �.L—oS�A3 Application is hereby made to the San Joaquin Local Health 'District for a permit to construct and install the work herein describe5[. This application,is made in compliance A County Ordinance No. 549. ��T-EC W _ pS�A-[tT-E,AQ E jl ' �—' OB ADDRESAND,LOCATION -Iz • " ., •,: :+•_•, ®.TZ_T _M...S „-^ . Owners Name- E`p-P•.�_L --r. 6!- F�. ------------------------------------------------ -•-- Address yp � 1Ph -ANr Y I � C ! 3 Ta-JCA..................... ------ � N " 4-------S- T-1�----5��- -�� one Contractors Name__ ---------------------------------- _ �Ct�a ' 11 __ Installation will serve: Residence El'-Apartment House EL Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 J... Lot size .- ��_.---------•--------•- Number of living units: _" .-__- Number of bedrooms Number of baths d i Water Supply: Public system [I Community system [:1 Private Depth T Water Table ""Q"_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam. Clay..Loam ❑ CI y [3 Adobe❑ Hardpan ❑ ` Previous Application Made: (1f yes,date-..-_.."_.-__--__--) No e"New.Construction: Yes No ❑ FHA/VA: Yes ❑ No e TYPE OF INSTALLATION AND SPECIFICATIONS: t4 if Se tic Tank: Distance from nearest well ___Distance from foundation k.--__f__ (No septic hank or cesspool permitted if public sewer is available within 200�fee�t_ � �...!--.Material------------------------------------------------- E:�ST)K No. of compartments-------it�-------Size----- ----------A-Liquid L th--- .---------Capacity Disposal •eld: Distance from nearest well...5-0-Distance from foundati rf_ ,-&.'.!---Distance to nearest 19t line-.5---------- 590, Number of lines..........I_-------------______Length of each line-.---i ,j1 . _..Width of trench------ ....... AV 17 Type of filter material4-RO-4:��_Depth'bf frlter.material__^��`��_�-.��Total/l le�enpth........�_�._�_ -__.-__ Seepage Pit: Distance to nearest well________________-__"_Distance from foundation--------------------- t � es of line } � F3G14 ❑ Number of pits----------------------Lining material---------- ---------.-Size: Diameter---------------........ -•- -------"-----------•-- Cesspool: Distance from nearest well--------------.:_Distance from foundation.____--------------Lining material------------------------------------- ri� ❑ Size: Diameter-------- ------Depth----------------------------------]----------------Liquid Capacity----------------------------gals. 0- Privy: Distance from ,nearest -_-._DisfancL from nearest building------------------------------------------ ❑ Distance to nearest lot line-------------------------------------------- ---------- 1 '" ? ---------------------------------------- ----------- - - Remodeling and/or repairing (describe):---------- ----------------'"trt---=-'-r_.-----------:.-•---------•----•---------•--....---•----•"-------------••--------"-•-•-----"-----..--------- n I �. *s ,.; ;'V %, . °- = ------------------------------------- •-------------------- �-- ----•------------ ------- ' # hereby ce y that I have prepared this-'application__-" .n- --3-•-----__�__-----work -•---- and that the work will be done in accordance with San Joaquin County ordinances, St a aws and es egul tions of the San Joaquin Local Health District. m t y oe (Signed)------- - - - •-- - ----------- ------ -- ---------------------------------------.--"------------------------------------------------(Owner and/or Contractor) By-------------------------- ---- ----- --------- -------------- ---------------------------------------------(Title)----------------------------------- ------- ---- (Plot plan, showing size of lot, I anon of system in relation to wells, buildings, etc., can be.placed an reverse side). FOR DEPARTMENT USE ONLY I ------ DATE------- p_, ----------=- I APPLICATION ACCEPTED BY---- -�i.r�_-..�- '-------------------------------------------------------•---- ------ IREVIEWED BY---------... - _ -------------------------------------------------------------------------- DATE------------------:-- -----•----------.--------------------- BUILDINGPERMIT ISSUED------•--• - •----------------•-•---------------------------•-- -•---- DATE.----------------------------------- ------ Alterationsand/or recommendations:"_°?•�-------------------------- ---------- -----------------------•--"-----------•------""---•----•-------------•--"------------------••-----------•------- i .._.....-•----------------•----•.. --------------------------------------- ------------------"----------------•--------------"--------••---------••------•-•---------..----------...----------------•------------...-•--_... --------------------------------------------------•--•-----------------------.--------------------- -------------------------- FINAL INSPECTIO BY:- Date g" �4P-------------- ------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Colifornla Lad],California Manteca,California Tracy,California E9 9 REVISED 8.59 2M 5-62 ATLAS " n a