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----�. FOR OFF1 -ESE: Permit No.�.�•----- ----- =ll{�� APPLICATION FOR SANITATION PERMIT --------------- ------ {Complete ':n Duplicate) Date Issued ... _----------------___..._- -------- This permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION----` 'SP -------..-;5------� ic}R.Y ---------------------------------------------------••----------------------------•——......... Owner's Name•--- 901 --- P�to ------------------ ------ ------------------------------•--•-----------._. Phone-.Mos-1_.y A.e. Address------&1��.%---------- ......x.!wDS.9,V------------------------------------------------------------------------------------------------------------------------------ Contractor's Name------Z.-� -- -' �f.�19 1�_l__�,�.'.1_r?.r--�--�c9.tifS---,�i�c� . -------•--------------------------- ..... Phone- .OF"..Q.:7------- Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---�__ Number of bedrooms'_ Number of baths ./.•. Lot size _._S __'__..X..__/..3" �--------------------- Water Supply: Public system ❑ Community system ❑ Private Xj Depth To Water Table MO.,_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam d Clay ❑ Adobe[+Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) Noe New Construction: Yes ❑ No L FHANA. Yes ❑ No L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---_----_-.._-_------•------------._----_-_-•_--. ❑ C(fSft No. of compartments---------- -------- ------Size--------------------------------Liquid depjh-...------------------_--Capacity-----•-•----•---------- Disposal Field: Distance from nearest well..-.-------------Distance from foundation------.-------------Distance to nearest lot line................. Uj ❑��ST 114 Number of lines-----------------------------------Length of each line------_------------_-------Width of trench.-...------------------------------ Type of filter material-_._--;------------------Depth of filter material-----------------------Total length-----------_-_------• ------------------ Seepage Pit: Distance to nearest well-_-------------------Distance from foundation.----l!J---------Distance to nearest lot line----- O� ® p� Number of pits--•---- ------------Lining material__ 4"' X-----Size: Diameter------: ��-_--Depth-----; 5�-------.._--------- �. Cesspool: Distance from 6darest well-----------------Distance from foundation-------------------.Lining material..---------------------.-----------._ ❑ Size: Diameter-------------------------- ----------Depth----------------------------------------------=-----Liquid Capacity----------------------------gals, ' Distance from nearest building Privy: Distance from clearest well - --- 9--------------------•--....-----•--------- ❑ Distance to nearestlot line --------------- ---------•----- -----------------------------------.---------------------.------------ Remodeling and/or repairing (describe):-------h11t7__.__T_C�_.----�.1�Cl�S:�l.�1r17?'-----Q�'-�/ - ---••--------------••--••-- -----------------------------= ---------------•------••---------•-----------------------------------------------------------•--------------------------- -------------- ---------•-------------------------------•-•-------• ------•--•---•--•--•-----------------------------------------•--••---------- ______ I 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. Y� p i (Signed)..........A a± .... ----------- ------------------------------------(Owner and/or Contractor) Br-------.... (Plot plan, showing size of lot, loca. ... - (Title)----- - -- -- ----.... tion of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ .-- ----------------------------------•------------ ----- DATI= - 1 -- ------- �------------------ REVIEWEDBY x - •-•-- DATE--------------------------------------•-----------•-------- BUILDINGPERMIT ISSUED----------------------------- ------- DATE__------------------------------------------------------- Alterations ATE.. _--------------------•---------------------------------- AFFeratians an Orr.9commenda,�,ons:----- - • --------------- --- --�- -----•------------------ •-----•--- -- .r�...l :_..<.�--= - "` . 1.= -------------------------------------------- to ------------ Imo' ------------------------------------------------------------------------------r••----------------•----------------------------- --------- ---••-- ..--. ------ --------- --------------- ------------------------------ ---- FINAL INSPECTION BY ............... ... t .�}, Date. 1 a ` -••----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS