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FOR OFFICE USE: ------------------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------ ------------------ -- ---------------------------- (Complete in Duplicate) I• Date Issued _____...1.. .....- --_.--_________________________---._.___.._.__._._.___ This permit Expires 1 Year From Date Issued 2-qt—-310 — 0 G Application is hereby made to the San Joaquin.Local,Healfh District for a permit to construct and install the work herein described. This-application,is.made.,in.compliance with Counfy'Ordinance No. 549. 17 +a c/. r. ►► �y , T� �--` JOB ADDRESS AND LOCATION...p�__..� .\1-2_2_2........ ISA. -l-1 .... -�Tl.:_.j A4 iS__ fir.��p�..��- I Da- Owner's Name--. _-ra,9111-----------I•---------------------•- •--- ----------------- Phone------------------------------------ Address...............P=••--•'•-• I, �C...'---_--..----- ��iF,�_T�C�..-• Contractor's –------------------------------------------- Installation ----••-•-•--------•----••----------•---•-Installation will serve: Residence g]�Apartment House 110, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms �__ Number of baths _j..-- Lot size ______________________ Water Supply: Public system ❑ Community system ❑ Private ❑Depth To Water Table h. ft. Character of soil to a depth of 3 f Sad Gravel `Sand Loam Cla Loam Clay Adobe Hardpan Greve ❑� Y � Y ❑ Y❑ ❑ ❑ Previous Application diode: (if yesj1date___ _________________l No New Construction: Yes ©'No ❑ FHA/VA: Yes [INo TYPE OF INSTALLATION AND SP ECIFICATIONIXTV4 Zvt (No septic tank=or cesspool permitted if public sewer is available within 200 feet.) 1" Septic Xn.�kl: -TIDistance from newest well------- ___`.Distance from foundation------._..----------Material ____'-1_ ____---_---------.-.-._.___ __________ oP„of comport encs SLiquid depth Capacity...... .. : N t J Disposal Field: Distance from nearest'well._ .LDistance from foundation...�C_J ---------Distance to nearest lot line._�?�~-..�, Number of lines-_..._-_. 9 Length of each line__._.__ ______________ � ❑ � { a �-•------------------- 9 �t_ � /r .Width of trench------ -�.---------------•--� Type of filter material__, Z__i_Depth of filter material______l _---------Total length--------4_0-__________________.__.. Seepage Pit: ,Distance to newest well----------------------Distance from foundation-------------------.Distance to nearest lot line.................. . ❑ Number of pits'-------------------Lining material-------------- -----.-Size: Diameter------------------------Depth----------------------------------- 1,4� Cesspool: Distance from nearest-well_______________Distance from foundation---.----------------Lining material--------------------------------------- (25 ❑ Size: Diametb�r l- ---�_Depth-----------------------------------------------------Liquid Capacity-------•-_-.-----------•-•gals,. :V) '____._Distance from nearest buildin Privy: +Distance from nearest well = g ❑ r Distance to nearest lot line--------------- ------------------------�-------------------------------------------------------------------------------------------- - -- Remodeling and/or repairing (describe):------------------------------------ ----------------•-•------------•---•--•-•----------- •--------------------------:. -•-----------•--------------------- ---••--------------•--•------------------------•------- ----------------------- --- ---- I i --------------------------------------------------------------•-------- --------------------------------------------•----------------------------------------- ---------1--------------------t------------------------------------------------------------ ---....--------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County. C ordinances, n and rules e d regulations of.,.the San Joaquin Local Health District. 1 • __.__._Owner and/or.Contractor) • __ /S to I%� �/1�" -•--•----------•---- -------------------�----------------- �---------------------------------• -..._ - _(Signed)----�---�.__ .....-,-••----------- i I Y r ( Titla len, showing saeiof lot, location of system in relati� - ---- - --••----'---------------------------•( )---------------------------------------------- (Plot ---- -.> B : --- - - -- ---- P 9 y on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` ----------------- ..--------------------- DATE .:-- _- - - ---�----------------------- APPLICATION ACCEPTED BY______ ._ REVIEWEDBY------------- -------------------------------------------------------- ------------------------I------------ -•-•------------- DATE-------------------.-..----•---•-••---•-----•-•------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------------------------------------•-------- AFFerations'arid/or fecommeridations:.,.». - ----------------------------------------YJ---------------•-- •-----•------------------------------------ ........--------- ------------------------------------------------- --•--------------•---.-.....----------------•----•-•--•--------------•---_...-----------•-- = -------------- ----------........ FINAL INSPECTN BY --- --- - ------ Date---- 777/3.7162—_------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 Wort Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,Catifornla ES 9 REVISED 8-59 2M 5-62 ATLAS