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ruKurrit_t?ur_: I rt <br /> -,k <br /> -------------------- ---------­--------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------- --- -- --------------------------- (Complete in Duplicate) <br /> -------------- -- -------------------------------------- This Permit Expires I Year From Date Issued <br /> Date Issued ... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB 'ADDRESS AN, OCATION---SPIC <br /> Pho <br /> Owner's Name--------&3 - .1 / <br /> / ........ .. ..... <br /> Address....................... <br /> �ff...... ---3V ..................................... ............. <br /> .............. ..... --------------------------------- <br /> Contractor's Name e___ ------------- Phon <br /> Installation will serve: Residence [] Apartment House [] Commercial F] Trailer Court [3 Motel (3 Other [I <br /> . Number of living units: ...._.-- Number of bedrooms 27!!- Number of baths'""'__ Lot size ....CX4�&�. ......�_ <br /> Water Supply: Public system El Community system F] Private�Depth to Water Table grip ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel C]"Sandy Loam [] Clay Loa Clay ❑ AdAdobe,, HaHardpan [3 <br /> Hardpan <br /> Previous Application Made: (if yes,date------------ ------) No ❑ New Construction: Yes; []No [] FHA/VA: Yes [3 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is'available within 200 feet.). <br /> _JQ <br /> Se ank- Distance from nearest well_VV_47__.'.Dist6nce from foundation-----/jO.*....Material.................. ------ <br /> No. of compartments...Z-------- ------- ---------------Liquid depth__.,X7_ _.!!........Capacity.,fft..:P". <br /> Disposal Field: Distance from nearest e'FlAig.......D'i,tance'from foundation-449 Distance to nearest lot line..... <br /> a� <br /> Disposal <br /> Number ofilines_ Length of each line-OZ-42--- Width of trench-- -­ -------1_ <br /> Depth of filter material----- - ------------Total length-------_------------------- <br /> 7yp; of filter material. ............. <br /> i. <br /> ion <br /> J <br /> Seepage Pit: Distance to 'nearest w-el Di stance roT o—un, a Distance to nearest <br /> Number of pits....I---------_-----Lining r�aterial_X Size: Diameter-ij-"----------Depth__.-A_!!1W#'1 C <br /> 1 11-1--------1 -7-—----------------1-'_,_. <br /> Cesspool: Distance from nearest well--------------- Distance from foundation-------------_---.-.Lining material-----...----.-------.--------.------.- - <br /> El Size: Diameter_,---------------------- Depth-'-----—-------y•---------------------------Liquid- Capacity......................!.....gal <br /> Privy- Distance from nearest well-------------------------------------------------Distance from nearest building--------------------_......j............. <br /> ❑ Distance to nearest lot line-----------------------------------------------------_---------------- <br /> Remodeling anr repai ri ng,-(de scribe): --------------------------------- <br /> __ __ _:------- ---- ------------ ---------- ----------------------------------------------- <br /> ------------------- -------- a, : ...: W- ----------r <br /> ------------- <br /> .......... 0--e------------------------------------- <br /> ------------ <br /> ----------- ----------------- ------------ <br /> ------•--------------- ---------- _------------ <br /> ------------------...... ---------------------------------------- ---_----------A__----------r----------------_------------ ___--------------- <br /> ----- ----------------------- <br /> I hereby certify that I have �rapared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I and rules an <br /> wl regulations of +he San Joaquin Local Health District. <br /> ............ ------------------------------------------- Contractor) <br /> (Signed),Ike_,�J <br /> By:............................................................. ------------------------------- <br /> I-_ (Title)--------------------------- ----------- <br /> --- -------- --------------- <br /> (Plot plan, showing size of lot, location of system in relation to ells, bui din etc.. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ,APPLICATION ACCEPTED BY.. -------------------------------------------------------------- DATE------=d----57 <br /> REVIEWEDBY------_-­------------------ --------------------------------------------- DATE--------- --------------- <br /> BUILDING PERMIT ISSUED--------- <br /> --_--------------------------*---------------------------------------------------*......... DATE.-------------------.-.-------- <br /> - <br /> Alterati <br /> .i�Vioa�nd/or recommendations:_ ---------- 41C--------------------. .. .... ----- - <br /> . <br /> ----------- <br /> ----------- ....... --- - ---- --- -----------------------_-----C7------- <br /> ---------------------------------------------------------------- ---------------------------------------------------*­*----------------------------------------------------------------------------------...... <br /> --------------------­---­--1-1------------------------------ --------- ---------------------------­_­-------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- -------- <br /> FINAL INSPECTION BY:___�. ......... ----- ----- ------------------------ Date------ 4G------------- <br /> SAN J AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-59 2M 5-4t ATLAS <br />