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7 OR-OFFICE USS M t <br /> : - -- - -- --------------- <br /> Y <br /> ---- - - -- - N - - <br /> _- APPLICATION FOR SANITATION PERMIT /r <br /> � Permit No. __. /-__� �5 <br /> ---------------------- -- <br /> (Complete in Duplicate) 3 <br /> ---------------------O- ��- --- This Permit Expires 1 Year From Date Issued Date Issuedlky <br /> f}o hereby m an Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Ihi p is ion is made in compliance with County Ordinance No. 549, <br /> J B <br /> PRE A Z LOCATION---.------ -- <br /> GLS..._._. _ <br /> ._ 7 <br /> t <br /> s'�+- �r ;;-N 1 <br /> /C5 ner s Name---------- -}-1 <br /> I --------- ----- --------�-------`-==-._--.:. Phone- -==-----:.�.�-��/ <br /> Address- • i__iQ Y' R_ <br /> A i<-------------------------------•----------------------- -------- - <br /> Contractor's Name­.-J..: <br /> F/--A''--'4:e- <br /> -------------------------------- --------------------------- ------ Phone_.-_. <br /> - ----------------- <br /> Installation will serve: Residence ®'parfinenf House ❑ Commercial ❑ Trailer Court [❑ Motel <br /> f Other ❑ <br /> Number of living units:,--- Number of bedrooms �_ Number of baths --t 7/_ ! <br /> ��. � ---- Lot size ---=---- --(/--�---- - <br /> Wateri$upply: Publicjsysfem NK'Co mmuriity system ❑.Private ❑ bepth to Water Table _ -___ ff. <br /> Character of soil to a depth of 3 feet. ,Sand ❑ Gravel p Sand Loam Cfa Loam— Cla <br /> Y ❑ Y ❑ I y ❑ Adobe Hardpan 0- <br /> Application Application Made: (If yes,date___________ ________) No ❑ New Construction; Yes <br /> No`.❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF-INSTALLATION AND SPECIFICATIONS: I <br /> �. [Not'septic faiWor cesspool permitted if public sewer is available within 200 feet,)` # - <br /> Seprtic'TanV,, Disfance from nearest well __moi_____Dista t fr -foundation o W- + <br /> 1. t Material ar'� -- 1 <br /> No, of compartments--__ -- - -•---- <br /> ---- ----Size-- ---{�--- ----�---�f-�---Liquid depth- -----G� 1.--- <br /> i --r�Capacify­'-170-foDisposal 1 field: Distance from nearer tell_- --_Distance from foundati n_ <br /> _Len th of each line T----Disttance fo nearest lot ly,e.-_ -------- <br /> ------------- <br /> Depth <br /> _____.. <br /> Number of lines_--____-- _ � -- ------- 1 , <br /> p real f4 =otalWidthlen of }bench------- <br /> T e,of filter maternal r- ------------- <br /> Yp De th of=flltec:mate <br /> ;h ! � I------ <br /> W <br /> Seepage Pit: Distance to nearest k efl-._-____�~._ Dlstance fr f nd � I ' <br /> l ' f afion_-___ Q________-DI t'n e fig nearest lot line __-.___,- <br /> ` Number of pits------ i Linin maferi �� -S � ! tp , I S <br /> 9 _ -._ ize: Diameter # Q%.De fn <br /> Cesspool:p Distance from nearest well________________ Distance from foundation materiel----------------------------------- <br /> Size: <br /> r Diameter I -------Depth------- -----------------------------------Liqu)cl' Capacity -----_.- --- gals. . <br /> ---- <br /> Y Dlstance from nearest well-__________________________---_----_-_-__---.-_-Distance from.nearesf building_;__--_-____----________---___----------- <br /> 0 >D <br /> Distance to nearest lot line_____________________________ <br /> Remo deling and/or repairing (describe)-____--_. <br /> -----------------------------------------------•-------------------------------- <br /> --------------•-------------- ---------------------------------------------------------------------------------------- -------------------•------ <br /> ------------------ .4 __-__-.-__------------------ <br /> _____________________________________ __ <br /> _--_- ......--- <br /> --------- ....._._ <br /> _--------------------------__Y_____.___-_______.-____ __-_-______-___ ____-___-_ <br /> I hereby certify that I have prepared_fhis-applica 'on.and_that,A rk .w,ill-_be_done-in_acco'dance with San Joaquin County { <br /> ordinances State laws; a d rul and regulations of a San 4doa in al Health District. <br /> J <br /> (Signed)------ ----- � ` <br /> : ----------------- ------------------------ -----(Owner and/or Contractor) 4 <br /> By: ,,i. .===`' ---------- ---- --- Tttle <br /> - ------- -f <br /> ? r 4 ? ( )'_ -i r---'f------------------ - ----- --- <br /> (Plot plan, showing size of lot,•location of.system.in relation to wells,,buildins etc., can be'played on reverse side}. <br /> �-� FOR DEPARTMENT'USE ONLY I <br /> APPLICATION ACCEPTED BY _______ ______________ t `/ � <br /> ---------- -------------------------{_ <br /> !c/DATE-1'------- t -�--- <br /> REVIEWED BY _- _ .. _- _-- .. ,,.._ .� <br /> = - - = - ----- DATE---. <br /> BUILDING PERMIT ISSUED --------------------------------------- <br /> ----------------------------- DATE = - - - <br /> Alterations d or r com <br /> ---- --- <br /> _ <br /> •moi ` "=+ ,ll _A:-r-/-r- f <br /> __ <br /> a ,mac - ----- <br /> vim. F. <br /> FINAL INSPECTION 13Y--------- - <br /> �..� ---------------- - Date <br /> -- ------------------------------------ <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ; <br /> 1601 E.Noielton Ave. 300 West.Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> E5 9 REVISED 8-59 3m 3-'63 F.p•CO. <br /> moi% <br />