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FOR OFFICE USE: 4 --------------- ----- ------- --------------------------- i ---------------------------------------------------- --- APPLICATION FOR SANITATION PERMIT Permit No. ..!.`�. _3. I a --------------------------------------------------------- Complete in Duplicate) � Z S- . (, )— --- This Permit Expires 1 Year From Date Issued Date Issued ... ?.`........ _ i 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_ 09p—SO 2 5', vv JOB ADDRESS AND LOCATION-/?X... ?.1" 3 ,c4_72?5;t�?-------7?'WQ.E'_-'-.._��='' •�.. T'rV�i�-/rG+s7� � h��"/'s�. Owner's Name------/ A.......Moff_.✓}iE?/h ------------------ -- Phone-.27 fgS�4_= Address--------------------Cly?i7? _ -------------------•----.. .............. Contractor's Name...-----'�' = /..-749 'l_. _.. Q11fc -------------------------- -----------.....---- Phone_eW..6,460..'7..... Installation will serve: Residence 911�APartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ Number of living units: __/.. Number of bedrooms._. Number of baths !� Lot size ____. _ _.. .._ _ J,.r ....... 1 Water Supply: Public system [I Community system [3 Private I� Depth to Water Table -____ 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--------------------I No R1 New Construction: Yes ❑ No tr FHANA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: ` _(No septic tank.or cesspool permitted.if public sewer is available within 200 feet.) ,., f_. a �G . SFptic Tank: Distance from nearest well_________________Distance from foundation----------._.-. Material_________________-. _-----.-..---- .--___--_-- El e;e No. of compartments--------------------------Size....---- -----------.----•---Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well... pl2--_Distance from foundation----/_.Q..........Distance to nearest lot line.....:: ..... ® AcU Number of lines---------------/------------------Length of each line---------:S-O'...........Width of trench..........A—Y."-'_-.----._- Type of filter material.--0900--K-----Depth of filter material.....ZA...........Total length............. 7;?_'___._...______•-__ r Seepage Pit:sVm( Distance to nearest well_____/_CL�7_.!____-Distance from foundation__..lp.. Distance to nearest lot iine.--,.�--___-_� Number of Its 1 Linin material__0..0 t_....Size: Diameter....3�1g.______.Depth_____- "�....E J Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Linin material--____------____ .� y 'Size Diameter-------------��----------- ---De th--�-------- �- •-•-�---�--------Li quid Capacity..--...............................9afs. Priv Distance from nearesfi well _- ______ _---------bistancefrom nearest building .__.._. Distance to nearest loft line----------------------------------------------------------------------- ___i Remodeling and/or repairing (describe):________��___-_. .e.eq,[ Q�.....? _.... '/rT//I/1 ---------—f,ep s........... ---------------------------------------------------------- ..... ------ - ._-- . _-._ -------------------------- --------- • S - y -p -----------------------------------------------q - q un -- --- ---.-•• -- -- -------- -----•----- - ----------- - -- -- - ------- ----------"".-----------•-----------------•--•----------------•- I hereby certify +hat I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. R I (Signed)--•-- SSCIWYr---------/HC------------------------------------------------------------(Owner and/or Contractor) By: c - R ------------------- --------------- ----------(Title)--------- --------------"----- ------- -to ----- �) (Plot plan,Tshowing-siie of lot,location o system in relation"to wells, buildings, etc., can be placed on reverse side).' ' " j FOR DEPARTMENT USE ONLY k APPLICATIONACCEPTED BY---------------------------------------------------- ------------------------------------------- DATE------------------------------------------------ --------- ------ ------ ------------------- DATE----------- BUILDING ------ - � REVIEWED BY-----------•-------------------------------------------------------------------- ---- - - I BUILDING PERMIT ISSUED-------------------------------------------------------- ! - � _. Alterations and/or recommendations:.__-__.:__.�'__._._ ----••--•--.....-----•-------------------------------- �I ------------------------------------------------------------ ------------------------------------------------------------------------------------------•-------------------------------------------------------------- 4 .. n ---------------------------................................................ ----------------------------------.-...---------------------------------------------------------------------------------•------- -------- ;c ` FINAL INSPECTION BY------------ ---- -- ---- -------------------------------- Date-------- f - I SAN JOAQUIN LOCAL HEALTH DISTRICT I! 130 South American Strout 300 West Oak Smut 124 Sycamore street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California II ES 9 REVISED S-59 2M 5-61 ATLAS