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FOR OFFICE USE: <br /> _%Q-- ------------------------- <br /> ------------ ---- ------------ rmit No. .....L-4 7 3 <br /> APPLICATION FOR SANITATION PERMIT Pe ............... <br /> (Complete in Duplicate} -Date Issued <br /> ------------------------- -------------------------------- This- Permit Expires I Year From Date' jjs�ej-f7-7,.. ....................... <br /> ----------------------- - <br /> ------------------- -------------- --- <br /> Health District for a permit to construct and install the work�erein described <br /> Application is hereby made to the San Joaquin Local Hea r . 1 <br /> 05 <br /> This apprication.is made in compliance wit Coun )r nuance No 549, <br /> 1�9 T ON../4 ------ <br /> 0 <br /> 5; <br /> JOB ADDRESS A A I -----------, . .. . ... ..... .. ... ..... <br /> ----------- -------------- ----------------_ <br /> Owner'stName Af-a'4VI�---------------. ............................. <br /> .......................... <br /> ...................... ....................... <br /> Address........... ------------- ----------- -------------- <br /> ..............---------­.. <br /> ... Phone........ <br /> --------------------------- <br /> _47 <br /> Contractor's Name... eAJ.- <br /> Installaflon will serve: Residence Apirtmeint House,E] Commercial E] Trailer u rt.:[3 , Motel 0 Other <br /> ❑ <br /> Number of bedrooms _3_ Number of baths Lot siz,e <br /> --------------------- <br /> Number of living units: J------- _-V <br /> i - 'Tablb <br /> Water Supply: Public system Ej Community system 0 'Private Depth to Water <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [-] Sandy Loam 0 Clay Loam Clay [j A�do6e[j Hardpan':[ <br /> Previous A: Yeshz No'[] <br /> revious Application Made: (If yes,date-------------------- No New Construction- Yes [I .No _ FHA 7e <br /> TYPE OF INSTALLATION AND SPECIFICATIONSi <br /> in 200466t. <br /> 4ad`if-�-ubliE's'ew-er is available with <br /> ---(No sieptiie-tank or cessp;ol-�permi <br /> Distance from nearest well____.7a--_----Distance, from foundation------ ............... ..... <br /> Sp.ptic;Tank: Dis re I , - 1'. <br /> . �1- <br /> Liquid de�th_­� <br /> Z ------------Capacity.... <br /> No. of compartments_--___'2-.-�.-----------------size <br /> Di I Field: Distance t 11 --------Disfanc from founclation-_1 Distance to nearest lot line.n��........... <br /> stance from neares;al ---15 e <br /> Number of lines Lengthlof each line---- !--' ..Width of.tre'nc ................-1...... <br /> P9 . __11-----W,---------- ------- % ---------­ I. '- 4-ig <br /> Type of filter,materia r.,Aed.ije h a --------- ------- ...... <br /> Z. -----Dept 6f filter material.... 1 length__..:. <br /> IJ T_ -ce- o .nearest lot line.....________..__! <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation.....................Distan f <br /> ❑ Number of pits----------------------Lining material-I-------- Depth--------------------------,--_--- <br /> --------Size: Diameter-------------------------- <br /> _C , 1: Distance from nearest well--------------_Distance from'foundation__-._____._' * -- ining material----------------I-------------------- <br /> eESP606kW <br /> ------------Depthl-------------------------------------------f----Liquid,�_a <br /> , pecity--------......------------gals. <br /> Size: Diameter--------------------------- <br /> I <br /> Distance ------ ...... <br /> Privy- Distance from nearest well---- - ---------- ilding.:-------- -------------- - <br /> --------------:--Dis <br /> Distance to nearest lot line------ ----------------------- -------- -- ----------- --------- :---------- ------_-------- --_------ <br /> RemoAeling and/or repairing (describe):----- -- T - - - -------------------------- - <br /> - ------ -------------t------_---------------------- -------------__------------------- <br /> _----------:-----------------____--_-_______-_____--________-- <br /> t -------------------------------------------------------------- <br /> 3 <br /> --------------------------------------------------- -------------------------- <br /> -------- ------ <br /> ............I---------------------­--------m--------------------------------------------------------- -------------I------------------------------------- -------------------------------- -- <br /> - <br /> I hereby certify that I have prepared this application and that the work will ge.4o'ne'in'accord'a-n6W"wifli Sin Joaquin County <br /> ordinances, St laws, and rules and t, of the San Joaquin Local HeAthDisfrict <br /> a io s <br /> �tre'" <br /> ----------- <br /> (Sign8d]1___ 0-71......T_9. .----------- ---------------------------------(Owner and/or Contractorl <br /> Cf-------------- <br /> ---------- <br /> ------ .. ....... <br /> -------- ----- ----------------_(Title)........ -- <br /> --------------- ----------- <br /> . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can b;�71�crj on reverse side). <br /> FOR DfPKRTMENT USE ONLY <br /> 1411� <br /> APPLICA, TION ACCEPTED BY_ - -- - ---------- -- -------- ---------------------------------------------------DATE----er ----_---------------------- <br /> DATE--------------- <br /> REVIEWED BY---------------------------------------------r------------------------------------ --••------,•----------•---•---------------- ----------------------------------------------- <br /> i. <br /> BUILDINGPERMIT ISSUED........------------------------------:-------------=--------___---------------------------------- DATE.-7-.-..... --------------------------'-.----- <br /> Alterations <br /> 1------ <br /> Atterations and/or recommendations:---------------:__: ........ 7-------- -I - ­' <br /> --------------------- ----------- 7 ..............m--------------------------------------------- ------- <br /> -------------------------------------------------------------------------------I-------------------- -------------------­-------- ---------------------7------............................... ----------------------------------- <br /> ------------------------------r-----------------------­­-------------------------------------------------- <br /> ----- ---------- <br /> -- <br /> ------------------1-1----------------*---------------------------*----------------------- . . . I, - : .-1 ., - - -----­ <br /> ............................. -------------------------------------------------------------------­------ -----------------------------­ .. . .................................... ............................. <br /> ---------- ------- ---------------- -------------------------------------------------- ---------_--------­­------- <br /> ---------------- ................ ------------------- ---------- - <br /> - <br /> ------------- ----------------------------------------------- --------- <br /> FINAL INSPECTION BY: -------- - <br /> - SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> CS 9 REVISED 0.59 2M 5-61 ATLAS <br />