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, , A D �// APPLICATION F®.R SANITATION PERMIT Permit No. -,(�ir.0P- --------------- - ---------------------------- --- ------ (Complete in Duplicate) -c t.--5T---- _-_ Date Issued ------ — This Permit Ex fres 1 Year IFrom Date Issued •- Application is hereby made to the San Joaquin Local Health District for a permit to cq truck al, iinst ! +he k2h�i r7escr�IIe d b I 4*6 This application -is ma in compliance with County Ordinance No. 549. 707' P-0 NJ, JOB ADDRESS' AN LOCATION._. ._ �� y i_PON ...... ----.---W..-.-a------- --- �-GAL_r D. _ Owner's Name -/- -- SQ ------------•----------- --. phone.................................. Address .-_. .4QX7Q1 = 1 Contractor's Name... - 11f AE3F Al ..........Q.w/N E j------------------------------------ -- hone--------------------.....------ - . Ph Installation will serve: Residence ErAparfmenf House [-] Commercial E] Trailer Court ❑ Mote! ❑ Other ❑ Number of living Lin its: .__._. Number of bedrooms ...Number of batths Z__ Lot size _.�Q _,x-_--` _-------- I Water Supply: Public system ❑ Comm IiL� system ❑ Private,�Depth To Water Table / - ft. Character of soil to a depth of 3 feet: . Sand eGravel E] 11 Sandy Loam LJ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C]Previous Application Made: (If yes dote_._= ""._) No-K New Construction: Yes 2!rNo ❑ FHA/VA: Yes PT" No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r -- {No septic tank-or cssspoolerm if ublic sewer is available if 200,feet.). _ =�00p Septic k: Distance from nearest well__7�-----Distance from foundation___ n � _ l!V_---------Mpatte�rial. p of comment" €? Se �! x`� Liquid deP;h _/ -------Capacity--- No. rri 1 '' ., Disposal Field: Distance fro m ares#`w -ll_._�c _-1_Distance rorrl foundation____ ___ ______Distance to nearest lot line.__. Number of lin I �- .r �� 6 /i y1 es Length, of each line. _ Wid+I) of trench.---- - ........_�.�� Type of filter rn.I ial---- Q --_Depfih of filter mate rvaf___.-,� .---------Total l ength...... ❑ Nu.rmr ba;ro,�„pats...__�.:_.P_,_ ____ Lirai gamma erial - undation____________________Distance to nearest lot line_.....__.__.__.r - Seepage Pit: Distance to nearest well _ ____ aDistance from fo Size: Diameter_____________ ___ ___.Depth :`_'___c:___:.- Cesspool: Distance from nearest we_ll_________________Dlstance from fb ndation___--.__._.__...___.!_i ----------------- Size. ----•-Size. Diameter------:----r'`------- --------------Depth_---•-.---------------------------------------------Liquid Capacity �I _ als. Privy: -- ------- g KDisncewlrm nearest well_______ __ ____ 6istance from nearest building---------------------------------------- C1 G ----------•-------------. vt ❑ Distance to nearest lot line.------- l 4- Remodeling Remodeling and/or repairing (describe)-----------------------------_------------------------------ �J ••---•------•---•----------------------------------•--- ------- -------------- --- v ---- ------------------------------------ = ,------ r t 1 hereby certif that) have prepared this application and that the work will be done in accordance withx5an Joaquin County ordinances, 5t e I s, and rules nd r'equ"` ns of_4:he $ari_Jo q inocaltHealth•Distri �. (Signed). -------- - ------- ._.. ""----------------_------------N ( wn rContract r) w - - -BY= �• _=•.-=-T. -- •- ----------------------- Title {Plot plan, showing sire of lot, location system in relation to wells, 60(Jl ngs etc:, can be placed on reverse side). '1► �'FOR�DEP�ARTMENT`U5E ONLY '' ` �' - -�-�r APPLICATION ACCEPTED BY ---- - DATE... l BYI ' :5----------------- BUILDINGPE2M.IT,ISSUp..... DATE---•------------•---------_. -- DATE- -------------------•------- w . AFFerations and%or recce mm .. &----------------- C 1-----_.-. 1�t . 7 - � U 4. � �°. . ------- - ----- I ` R•-©' -- - - -------------------•--------- -------------- ----------- - -- •---------------- --- ------ ---------- ----------------------------------------------------------- -------------------------------------------------- Date -----y--- •---------- FINAL INSPECTt BY:.. -- - -- --- --- -- --- - �-- SAN JOAQUIN LOCAL HEALTH DISTRICT s: 130 South American Strut 300 West Oak Street _ 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California1 �'•.. Mangca,California Yracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS