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FOR OFFICE USE: <br /> --------------------------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- <br /> /.. ./.._. .. <br /> (Complete in Duplicate) <br /> Date issued --- <br /> -------- -—--------- -------- This Permit'.Expires 1 Year From Date Issued <br /> Applica+ion 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 m de in compliance with County Ordinance`No. 549. 4000 � = 2-117—13 0-b ' ' <br /> Sim <br /> S C/�}Lt?!1� <br /> JOB ADDRESS AND��LOC r'' h NA N--------- LLFz : <br /> Owners Name......' __ r vl t ...__(� t-6 ------------------------•--••-------------- Phone..........._-----------_--•--•--- <br /> -.._.. <br /> tx,.�, S_ ....- -, , 1-Q-. <br /> Address _ -- --- -.... _ - .... ----------------------------------- <br /> ------- ---- ---- <br /> --•`....................j�_- 4 s. .---- ------------- ----------- Phone: ......_..... <br /> - <br /> Contractor'sName--'. .­,.:._____ ,,, <br /> Installation will serve: Residence'. Apartment House#'n Com nAercial ❑ Trailer Court ❑ �Motel ❑ Other ❑ <br /> Number of Irving units. __�t:.._ Number of bedrooms __-.,-. Number o baths ___L Lot size .._ __..-.- _ .....----.- + I <br /> Water Supply: Public system fi Community syst *Private epth To Water TableZ�ft. f <br /> Character of soil to a depth of set: Sand G}rab I ❑ ndy Loam Clay Loam ❑ CI y ❑ Adobe❑ Hardpan ❑ 4_ <br /> Previous Application Made:_(If.yes,date-------------�f. ) o� New Construe+ion: _YesNo ❑ F_ �.HA/VA_Yes ❑ No <br /> . <br /> _ <br /> TYPE OF INSTALLATION A�rNd I PECIFICAT16NS: - ��-- <br /> (No saptic tank or c4sipoopermitted if public sewer is a�.ailable within 200 feet.) <br /> I Septic Tank: Distanc%fro� nearest well____._---__----_Distance fro foundation--------------------Material----------------------------------.-....._-._-... <br /> Xl �' No. of Comra <br /> .+menti- ----•-----------------Size------------_ ------..,._.Liquid de th-----_ -•-- 3tt-- a aci <br /> q RSP tY y <br /> Disposal Field: Distandfrom nearest well--"1----.-_Distance from+fou dation...~'_..._--__-Distance to nearest lot line.._)l.......... <br /> � �� Number sof vines-.---_--I__--I------------------Length of each line-- '- _-s971r" <br /> ...Width of trench.-....---'.� ...---------_-.... <br /> -.--Total length <br /> �ID% Type of t�lte nateria�l._. ��•K----Depth of filter material.....,( -_-__. � <br /> Seepage Pit-' Dis#ance:to wrest ell---_�Q-_--_-_Distance from foundation .��0� ._ ista a to nearest to line.. <br /> Number'of'fits_ - .-.-. Linin material__- - C-_Size: Diair�- .-.._..,Depth.-...1- -......__ <br /> l� P r g <br /> Cesspool: Distance fro nearest well-----------------Distance from foundation---.--."�" _rLgning material_.--------__._.......--.-__-.___..... <br /> enc �.� <br /> ❑ Size: Diameter--------------- -- •-------------Depth-------•------• ------------------------------------Liquid Capacity.._-----------•---••-•---•gals\ <br /> It <br /> Privy: Distance fronearest well----------------_-.----_-----_------_-.-_-_.----Distance from nearest building--_-----_-...---____-_---__.__-_____--..-- <br /> ❑ Distance;f 1�arest lot line,: <br /> ... <br /> Remodeling and%o'rlrep�Er�ng (de'rscr 13.e):--_ - - - __- 4. '!_^� goo <br /> ---EAS-:CLi� <br /> _a - ', ° c�----` '7 �N ---------T-1 --c? <br /> ••---- -•-�--- - ----- -- -------------------------------------------------------- <br /> e <br /> ------------------ --- - ---- --------- I <br /> work will be done ryn accordance with San Joaquin County <br /> ! e b certifythat I have prepared this application anal that thl � g • <br /> ordina es S e a s an ruffs and regulations hof the Sa"boaquin_ _ocalH,e�It District. <br /> (S• +F_0�_ -Owner and or Contractor) <br /> igned)__=- - �-_ -----.�--------------------- ---- -- ---------------------.....-..- ---- _-( /_--_._---- - <br /> r fi <br /> Br----------•---------------------- .............. --------- -------------..----------------;��;----------.....-----------(r+�e)- � - .-... <br /> 1 (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ------------------ ------- -•--•-------------------••-------------- DATE-•----7------ -----=---------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING.PERMIT.ISSUED_.t- _..._.- .....- - -�.D�4TE:.----------- r -------- <br /> Aheratiotis and/or recommendations: -> _ _!E -y'a! - --------- -------••------- ------------• -----•----•--•-----•-------•------------•----•-----------••-- •------ <br /> 9 <br /> ---•-------------------------------------------------------------...-. -------------------•---- ------ --------------.... <br /> --------------------------------- --------------------•-------------•--•------------------•--- ;;' <br /> •-•------------------ - <br /> -. e---- ------ -- --••- <br /> ... ........... •----- --- ---�- ----•------•-•--------------••------------ ---------------- -------------•-•-••-------------- <br /> FINAL INSPECTIa - : ------------- --Zov Date - = <br /> x <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br /> ti �a <br /> i <br />