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------------- -------- <br />--- -------- V <br />------------------ - - ------- APPLICATION FOR SANITATION PERMIT Permit No. <br />------- ---------------------------------------------- (Complete in Duplicate) <br />------- --------------------------- •------------- - this Permit Expires I Year From Date issued Datip Issued ......... 9!_ <br />Application <br />lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />T application is made in compliance with County Ordinance No. S49. <br />JOB ADDRESS AN 10C T 110 N - 67 <br />. ..... ... <br />_�T-- <br />Owner's Niriiia, 7!43��� <br />11---------------------------------------------------------------------------- Phone .......... .................... <br />Address_,4.70,6 ----- e..� ---- 7, <br />$ .., ....................................................... . ........................................... ................... <br />Contractor's <br />0., e�L <br />.................... ------------- --------------- -­-------------- Phone. <br />Installation will serve: Residence 10 Apartmeft House' 0 Commercial F <br />-1 Trailer Court E] Motel EI Other 0 <br />1I <br />Number of living units: ... /-- Number of bedrooms .1 --- Number of baths --- /-. Lot size <br />W............................. <br />ater Supp <br />!*.�Publicwsystem-B f <br />a er Ti6l;�f,., <br />Tc,'.o m -mu h"fy - _ts` `0 1 `_Deo*� 'to wif- <br />6-haracter of soil to a depth of 3 feet:-4� Mdb._C �ravel__o _n y.4 0'a lay Loam 0 Clay [3 Adobe -0 Hardpan C] <br />I <br />1!evious Application Made: (if yes, <br />Pi, clate- ----------------- ) No aw Construction: on: Yes No E] FHA/VA- Yes I-] NOR <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool pormiffbdif:Fubls'c—se—w*e"r--is,-a—vailabI within 200 fee+.) <br />)_ I <br />Septic Tank- Distance from I nearest,weII__4Y_0_"_.. Distance from foundatio) <br />No. of compar-tme*nrt.,",____,2 ------------- Size ----- 9_XA_-A ------- <br />_j ..... Liquid depth-.. 4- --------------- Capacity -2050. <br />Disposal Field:Distance from D �neareJt ........ Distance to nearest lot line ........ 5 ... of <br />i[ Number of lind.s. -------- I --------------------- Length of each line__4�9 ----------------- Width of trench...._ Type of filter material. .0 X <br />4 L% - ----- Depth of filter material.1-1.q- <br />It ---------------------- Distance from <br />Seepage Pit; *Nlaolsiarce o ne rest well'_� <br />T - I . foundation --_--------------- Distance to nearest lot line ----------------- <br />I El Number of'pits ..... pt�,:_j -----Lining material ----------- ----------Size: Diameter------ _-------- Depth------------------......---_----- <br />%lit -41 "�r`omlneare, - <br />Cess pool: <br />if8nt' nearest well ------------- - Distance from �ounclaf ion ---------------- 2!�E�ining;?n&tgrial. -at . ........ <br />-------- ---- <br />El'.4 .4r.$ -­------------- ) -------------------- Depth ---------- ------------------- Liquid Capacity ---_----------------- <br />----------------------- __.ga s. <br />Privy: Distance from 1hserest well_______________r- - v I 11 <br />i ------------_- I -------- ---14-Distance <br />_ from nedirest'6uilding ------------- ------------ <br />I Distance to nearest lot line- <br />------ j ; <br />an <br />d/oilnr� re <br />pa4ngaesdribi <br />1E6 .--•---••-------•---...--•--=----------------------------- -- <br />.......--------------------------------------------------- <br />Kemodeling ij. <br />►............. --------►- <br />------------------ <br />-4 .,r x <br />-­--------- �: ----------------------------------------------------------- ........ ..... ---- <br />---------------_------- -----­------------ <br />----- ------- - --------- t <br />nk <br />-------------- <br />---- ------- -_----- -------------- ----------------­---- ------- -- ---------------- ------------------------------ x ------------_ <br />----------------- <br />---------- <br />�e done cert*f ' fVafT0av'e "ap plicati6d and -f h -if -At work ill o S jun <br />rT that 1. have prepared 'a 'T accordance with an Joaquin C ty <br />r <br />Idlin' I 'ru, m <br />ordinances, a arid rrules a' eg� MRns of the Sa-n Joaquin Local Health District! <br />-------------------- Owner and/or Contractor) <br />----------------- ................. <br />........ ........... . ... . .. L -,;- <br />. .. ........... ---------­----------- --------- ----------------•-_-------------• --------- <br />5 a 0 10 <br />---------------------------=------ ----------- <br />(Plot plan, sho ing size of lot, location of system in relation to wells, buildings, etc., can be <br />glaoed on.reverse slide).' <br />otit . <br />APPLICATION ACCEPTED BY_- <br />REVIEWED . BY------------------------------- <br />BUILDING PERMIT ISSUED__------___ <br />AZyrations and/p.mmenclatic <br />_ 1 ` -ec . M <br />Wrtl ........... ll=_ <br />FINAL INSPECTION BY:-& <br />T <br />130 South American Street <br />IIStockton, California <br />ES 9 REVISED S-57 2M 5-61 ATLAS <br />FOR DEPARTMENT USE ONLY <br />/--je ------ - ------ --------------------------------------g ----------- DATE ------ a----- <br />—.! P —. , ' <br />-- ---- - --------------------------------------------------------------- - I DATE-------------- <br />I------- --- -------------------------------------------- <br />-------------------•--------•-•-----•--•-....----------••------------------ L ---------- DATE ----------- <br />------------ -------------- --- ----------- --------_------ <br />------------ <br />' <br />--6 va_ E_; ------ <br />,r V -------------- <br />----------------------------- <br />--j G_Z1 ---------- ............. <br />----- ---------- Je ---- --- ----- ----- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Lodi, California Manteca, California Tracy, California <br />