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FOR OFFICE USE: ---------------------------------------- - ------- APPLICATION FOR SANITATION PERMIT Permit No. _. 5.. ... .1 --------------------------------------------- (Complete in Duplicate) 4 / Date Issued --------------------------------------------------------- This Permit Expires 1 Ye sr From Date Issued ....._ ....1 . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein descrbed. This application is made in compliance with county Ordinance No. 549. ZQ 6� T�f-�`{A,) 11W e'd-FI7 rVr eF'O N /r47TL E .1W Zl%o ST, Z,1 X4171' 0/1 JOB ADDRESS AND LOCATION SONTN sir 'PA�rT.....r' E�i� 7-5F._;BP_!.............................................................. Owner's Name----- -------- --------------------------------------------- ------------------------------- Phone------------------------------------ - Address--------------------?!! �---------'6-X...... p Contractor's Name------- 105s'-----�w�------------------------------------------------ Phone,:�>r� � a Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court F1 Motel El Other ® T/ ,92I c c'12 Number of living units: ___/__ Number of bedrooms __7-:7Number of baths ___(__ Lot size ---------2�S�_.__-_fX__af'f '_________.. Water Supply: Public system ❑ Community system ❑ Private JM Depth To Water Table ------- Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No Z] New Construction: Yes ® No ❑ FHA/VA-. Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �j Septic Tank: Distance from nearest well-/-490-:_--_.Distance from foundation------/a_.......Mate r'a]....._�'�G_'.---- .......... p �] No, of compartments------._.�-----------Size_ -----------Liquid depth------- Capacity-----ere O Disposal Field: Distance from nearest well/&0Q2---Distance from foundation-___AP..........Distance to nearest lot line../.-4...Q..'..- 23 Number of lines-------------/--------------------Length of each line--------- Width of french----------- --- of filter material.E��P. 7_K_________Depth of filter material-----/........Total length________________LY- __......_...____ Seepage Pit: Distance to nearest well._JAn-�_--_-._.Distance from foundation----��___Q.._..Distance to nearest lot ® Number ofPits_-_-.-_-I__._______Linin9 matenial.l��s /.__.Size: Diameter__ ... .Depth-------e; S—-------------- Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-_..____.-..___-____________._....... El Size: Diameter--------------------------- ------ ---Depth------------------------------------ ---------------Liquid Capacity-----------------------------gals .., Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building_________-.-_-.__--.-.-..-_-.-_.-.-___.-. ❑ Distance to nearest lot line----------------------------------------------- ------------------------------------------••--------------••------------•-------------•-•----- Remodeling and/or repairing (describe):______/_.Ns ¢L___.---5°YS7- --•-- ---- 7- --------------- All - •------------•---•------•-------------------•---•----------••-------• -----•---------------------------------------------------------------------------•--------------••-•-----------•---------------------------------- ---------------------------•---•--•-------------------------------•-•---••-----------------------------------------------------------------------------------•---•--•----..__...-----...-•----------------------------------- --------------•--------- ------•------•------------------------------------------•--------- ------------------------------------------------------------------------------------------------------------------------- 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. (Signed)--------------- ....... ------- ----- ------- - ------••---------._.(Owner nd/or Contractor) By:------------'wiz..�--- ��`� _-�act ---------------------------------------------------(Title)--------------- .... .._........-- .._...-------- (Plot plan, showing size of lot, Iota+ion a system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY QATE. ..—,.. APPLICATION ACCEPTED BY_ z� ._-_ _ ..mss ________________________________ .�-- _- - REVIEWEDBY--------------------------------------------------------------------------------------------------------------------__.... DATE._-------•--•---------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------- •---•--••-------•--- --.._. DATE-------- - -------------------------------------------------- Alterationsand/or recommend'ations-------- -------------------------------------------------•------------------------------------•----•----------•--------------•-•------------------------------- ------------------------•-----------.-------------•----•---- •-•--------•--•---•----•----.--••----------•--------------------...,.....--•---•--•---------------- ------------------------- •-•----------- .-- ----------- -----------------------------------------------------•-------------------------------------•------------------------------------------------- --------------------- I FINAL ------ •----------- FINAL INSPECTION ----------------------------- Date--- ------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9111h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS