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FOR OFFICE USE: <br />------------------------------------ ------------------- PERMIT Permit N ... <br /> APPLICATION FOR SANITATION <br /> (Complete in Duplicate) Date issued <br />----------------------------------- --------------- fres 1 Year From Date Issued <br />--- --------- ------ ------------- ------- -------- --- This Permit Ex dinstall the work herein described. <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct an <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LC)CATION...... <br /> ' --------- --------------------------------------------------------------------------------- Phone.. <br /> Owners Name <br /> ................................. <br /> Address------- -----------10-1----------- ------------ ------------------------- <br /> Phone...-------------------------------- <br /> Contractor's Name-------•--;" 'A <br /> ------ ---- ----- -------- --- <br /> . ...... House-e 0 Co mrh&r ci al C] Trailer Court 0 Motel 0 Other [I <br /> Installation will serve: Residence [Apartment H .4 1 / <br /> Number of bedrooms j--- Number of baths --/-- Lot size '65�0__Zlf�p_----_--_----------------- <br /> Number of living units: .-___ / <br /> th TO Water Table. _T <br /> t <br /> Water Supply: Public system El Community system 12?"-Private 0 DepClay C-] Adobe 91--'Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loom D Clay Loam 0 0 _❑ <br /> FHA/VA. Yes 2RO�NO 0 <br /> Previous I ous Application Made. (if yes,date-------- -------.---) No g?""New Construction: Yes [Re<o <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) <br /> lafe�"al <br /> Septic Tank- Distance from nearest wetl____:7:7=-----Distance from foundation-JAI........... -- ------------------- --- ------- <br /> ---71Z­­-:� Capacity..e4!�?e/----- <br /> No. of compartments------P.......__-----Size,. 3?-/-Vi?.......Liquid depth .1 <br /> UK" nearest well-_.:77:=.-Disfance. from foundation 2�..........Distance to nearest lot line. ~......... <br /> Disposal Field: Distance from n� Length of each of frenCh.,Z_--'__*_-------------------- <br /> Number of lines-------49- ------- length__A�v----------•------- ------ <br /> Type of filter material-/_ & Depth of filter material-- /0�--------Total t line- <br /> r f dation___/ <br /> &4.......Distance to nearest lo V00----------- <br /> Seepage if: Distance to nearest well----7=!=---------Distance f_pm ovn 91 - <br /> Diameter_ /- ---------Depth, <br /> Number of pits__.- ------------Lining _Size: ?1_ <br /> I& ------------Lining mate ri al.�&O�CV 1ining material--------------------------------- <br /> Cesspool' Distance from nearest wellfoundation__-.--------------- <br /> -------- --------Distance from Liquid Capacity---------------------------gals, <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well___---------------------------------------------Distance from nearest building---------------------------------------- <br /> Distanceto nearest lot line-------------------•-------- ----------- --- ----------------­----I--- --------------------------------------------------------- <br /> El .0 - -__ .- ­__I­---------------------------­--------------------- <br /> 4?4 ------ - <br /> Remodeling and/or repairing (describe):----------7, eA_1- ---------4-------------------------------------------------------------- --------- ....... <br /> ---------­--------------------­------------------ - <br /> --------------------------------------------------- <br /> ------------- -------11-----------------------k-----------------I--------------------------------------- <br /> --------- -----••-----•---•-----•------..._-.--------­--- ---------------------------------------------- -------------------- --------I---------------------------- ------ <br /> -- -- -------------- ------ - --- ---- -- --- - --------- <br /> - ------- --- ---- - -------- <br /> ---------I­hereby certi-fy Sha <br /> ha-t I have p-repar -01-i-ca-tion.and__that__t.he__wo-rk__will__be-d o n a in accordance with San Joaquin County <br /> ----- --- ---- <br /> ind regulations of the San Joaquin Local Health District. <br /> ordinances, State laws, and rules a <br /> w0i.Contractor) <br /> (Signed)--------------------------------------- ---------------01&-- --- - ------------- ------------------------------4ct==t <br /> --- --------........ <br /> -!!u, <br /> By:----•--------••-•---------------------------------------- ----------------------- <br /> ---ells --- <br /> ells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system in relafio <br /> R DEPARTMENT USE ONLY <br /> ------------- <br /> ------------- DATE_----- - - ---- <br /> APPLICATION ACCEPTED BY DATE-------_--------------- ---------­------------------- <br /> ----------------- ------------------ ------------------------------- <br /> REVIEWED <br /> --­---------­ ------B----Y--------------------------------------------------­----------------------------------------------------------------_---------------------------------------------------------------------------------------------------------.--.--.--.--.--­.-.-.-7--------_-------------------------- <br /> --------D-----A------T <br /> BUILDING PERMIT ISSUED.-------- - <br /> Alterations and/or recommendations.;.�.__./�---- --------Z <br /> --- -------------- ------ --- <br /> -E------------------------------------------------I------------------------­------------------------------------------------------------------------­----------------------------------------------- <br /> ------------.---.---.---.-_-.-- <br /> .- <br /> ---------------- <br /> .........­------------------------------------ ------ --------------------------------I------------------------------------------------------------------ ----------------------- <br /> -------­---------- ----------------- -------------- ---- -- --------- ------------­-------------- ------------------------------------------------------------------------------------- <br /> ........... ......... . ------------ <br /> ------------------ <br /> ------------ <br /> Date--- . ____/_x <br /> --- - ------ -- ---- - ------------------ <br /> FINAL INSPECTION - ------- ....... .. --- - --- ---- <br /> S JOAQUI LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />