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t-UR OFFICE USE, ---------------------------- ---------------------------- . ------ APPLICATION POR- SANITATION PERMIT Permit No. .... ._ � � (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ........ �- =Z57--t3a-0.6 Application is hereby made to the Sen 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. S49. JOB ADDRESS AND LOCATION----W------I_) �: � 1 ------RD., 014 Owner's Namely C-�` ��- (e - - --- --- ------------- ------ Address Address .r(..' Contractor s„„Name. ----------awq i= _ _ Phone------ -_-------- Installation will serve: Residence [�F Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r - Number of livingunits: __�. Number of bedrooms _ 60 ) -L. I _� Number of'.baths _--�-� •Lotslze��.________.�.__.f��----------------- --- Water Supply: Public system ❑ Communi s stem Private ��1 44 40 -;+o l€ + tY Y ❑ Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ y , Clay ❑ Adobe❑ Hardpan ❑I p DB'-Gravel Sandy Clay Lo Previous Application Made: (If yes,date-------------------_1 No New ConstruEtion': YV'�es ��IQo ❑ FHANA: Yes ❑ No ' Er TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - - Septic T nk: Distance from nearest well _-_._Distance from foundation----- n--------.Material__-C/2NCR1- :T�-------_ No. of compartments--------.�----------Size_� . 1 _x__ _._Liquid depth---------- ------------Ca aci .� _.- P tY•-/ - .0_- - Disposal Field: .,D.istance from nearest well___.-.. Distance from foundation.___ �4 „ r -. 71�.. ___Distance to nearest lot line_____________ Number of liries_:_l+►"° * .'"''" �'" g �a� line___.`©_-'t_� _Width of trenci�_____---V_0 3 ---- Length of each ��. . Depth of Zmaterial__d19______-�_--Total length---------�7 -------------- Seepage - - See a e Pit: Distanceof ftloen eaest Iwell- .D stance fro}mrf �t� P. #� ❑ Number of its___- - 1ze --Distance to nearest lot line...... P 9 . �erg v+�.,�:.� ::,,;r P -------•-------Lining material---------- oun tionDiamete Depth --------•- Cesspool: Distance from ne rest well-__.-�,___...__Distance from foundat;on_______ Lining material..._.___. -------------•-••--------- ."' ❑ Size: Diameter---- �-..-Depth---------------------------------------------- I---Liquid Capacity..-------------•-•- --------gals. Privy: Distance from nearest well------------------------------ --- D;stance fro`""m nearest building------•-•-------••--•- ❑ Distance to nearest lot line_--------------------------------------- I --1--------_---_-_-_-_-_----- f _ 1t •- (f -_-_1 /• 'I!/ - ---•---•----------•---------------------- Remodeling and/or repairing (describe 1_ �. .f_�1 .efl_----Ja-1��Cb:T - •- 'T-.`' 'c T f- ---------_---- --��=-----—ir------------------------------------------------•------------------- ------ I hereby certify that I have prepared this application and t atr he work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San14Jaaquin Local Health District. 1 (Signed{-- r`-�'- --- - �----- .- ------------------------------------------------ ---------------------------------------- -------------- -[Owner and/or Contractor) ------_------------_- -----------------------� �:,�.-- Title Plot len, showing size of lot, location of system in relation to welrss, { ) Y' [ P 9 buildings, a+c., can be placed on reverse side). l OR DEPARTMENT USE ONLY APPLICATION�PACCEPTED BY--- -= -1--p- --- --- ----LDA REVIEWED BY------ ++� -,_ - DATE BUILDING PERMIT ISSUED-----•----------- _ ... DATE Alterations and/or recommend'a+ions:-•l-------------------------•----------••---------- i ----------- ------------------------------------------------------------------------ •----------- ---------------------•---------- -------------------------------••----------•----------•---•--------•-•-•----------••-------•------------• --••-------•-•------ _.....----•-------------••-•-----•-•----------•-------•---......---------- --A-- --- ----------------------------------------f� ---- X- •--•------- --- ---- FINAL INSPECTIO Y' - - - - - ---- -- ---- --- ------- Date--------- -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 west Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California It$ 9 REVISED e-59 ZM 3-61 ATLAS -r^7 '+.�