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FOR OFFICE USE: ------------------------------------------------------- ` -.-.._-__--___________ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..,1 ` -------------------------------------------------------- (Complete in Duplicate) �1 Date Issued - ------------------------------------------------------ This Permit Expires 1 Year From Date Issued ,.�_2S-0S0_of, 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. Cf3L113 L JOB ADDRESS AN ION .�✓_ CLL- -----BLOCAI BL- -©TT ...... Owner's Name--.-------- --•-- 1 ------------------------- "" >'`' � ------ ----------------------- Phone............................... Address . Contractor's Nar1�e' _• Q UU ----- -------•-•--..._ Phone........---_-------------------- Installation will serve: Residen a ent House [3r�� Commercial C] Trailer Court El Motel ❑ Other Number of living units: ----- Number of bedrooms -2--Number o"baths .1--- Lot size -------------------______.......... Water Supply: Public systemY0 Community system ElPrivate epth To Water Table�,1:2?. ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hard an ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes 12--l'4_0 E] FHA/VA: Yes No ❑ TYPE OF'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�snk: Distance from nearest well____,)�__ Distance from�nda on----/a-------.Mater'ai.__, � C I { --------- No. of tom artments_______ ( ata nd on uid de th_________ Capaci -;C�-----i-- P 9 P. Disposal Field: Distance from nearest well._.5-01D{ , fQ_ __.__Distance tolnearest io.f line._-_�?_.___._.. l f` Number of lines-------�_______ ________________Length'-of each line•_____ ------ Width of trench----33 ?_.._ Type of filter material,. C/' - De�th''�b'f fiiter,mater� I____I _______Total length_______/C--_©_.--------------------- Seepage _�______________ ,..1 Seepage Pit: Distance to nearest well-___________________+Distance from founds ion___.___.___._...___.Distance to nearest to line____f________-_. ❑ Number of pits----------------------Lining Aaferial-----------------------Side: Diameter-----------------------Depth--,--- .......... Cesspool: Distance from nearest well----------------Distance from founda[ion--------------------Lining material-------,-- .------------- y- �1 ❑ Size: Diameter----•---•---------------------------.Depth-----------------------•- ------------------------Liquid Capacity-------- .............. gals` Priv Distance from nearest well----------------I ______-_._.-Dia ante from nearest buildin C❑ Distance to nearest lot line-- ------ ---- ----------------------------------------------------------------------------------------------- ------------------------ Remodeling ------•-----•-------- t� Remodeling and/or repairing )describe): -----------------------------•-•----.._...----•--••-------- ----••-•-------•--- ----------------------------------------------------------------------------------------------- ------------------------------------I--------------------------------------------------------------I-------------------- ----------------------•----------------•-------------------•------------------------T--------- . ----------------------------------------------------=---------••.......... - -- I hereby certify that I have prepared this application and that the prk will be done in accordance with San Joaquin County ordinances, State laws d rule nd regu 'ons of the San Joaquin,Loocal Health District. (Signed)-c__✓-- ---•---------- `---------A,-, ------------------------------------------77-F-7-7 ------------------------•----------------- -(Owner and/or Contractor) ih By: -------- ----- Title Y - ----------------------- _ { ) (Plot plan, sHowing size of lot, location of system in relation to w hs, buildings, etc., can be placed an reverse side). FOR•DEPARTMtNT-USE-ONLY 't APPLICATION ACCEPTED•BY-==----1 f=T��r------..- 3----- -----••---------•------- •DATE-•-- J�J� � � ---------------------- REVIEWED93 ------------------------------------------------------------------------------------------------------------------------- -- DATE--------------------- BUILDING-PERM IT-ISSUED--- -------------------------------------------------..;...--.-------------------------------------------------------------- DATE.DA-TE---------Q---- -------------------�----.-_- "--.----.-.-- -- ------ Alteration/or recommendatio : ------(---- �-Ct#....... 1 -�k � Tt ......0,_K_ ---------•--•--- -- - - ------------------------------------ -------------------------- ------------------------------------ ------------- ...... --------------------------•--- a�- .R--- ----------------------- --------------------------------------------- -------------------- •-------•------- -- _ FINAL INSPECTI Date -"'" ` '' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 Wast Oak Strut 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS +'" �