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FOR OFFICE USE- <br /> ------------------- <br /> SE:------------------ / - � <br /> )APPLICATION FOR.SANITATION PERMIT Permit No. 1.��. <br />----------------------------=--------------------------- (Complete iq,Duplicate) fa- V_ <br />--------------------------------------------------------- This Permit Expires 1-Year From Date Issued <br /> Date Issued . <br /> Application <br /> r <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 /> . <br /> JOB ADDRESS AND LOCATION=----- 4- ---7__...... ------ ---- C-----------------------------------. - . _ _ <br /> (1_111/1d.&&-1%"_V <br /> '` ,,// 7 <br /> Owner's Name......Srr/�C G�.c�,a.....-- ---------------- ------ Phone__!'_-_�-_`�iS� I`' <br /> 7 <br /> Address. ;i --------------•-----'---•-------------- ------------------------- <br /> ------------------------------------------------------------------••--•------------ <br /> Contractor's Name ...--- -------------------------••-- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: .�tmmunity <br /> mber of bedrooms __ 74 3 _ IJ <br /> �-Number of baths ____I_ Lot size .............. ....X---•-----••-- -•---,-,-............. <br /> Water Supply: Public system system ❑ Private ❑ Depth To Water Table 6.... <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy [.oam 0 Clay Loam ❑ Clay ❑ Adobe EF-114rdpan [ <br /> Previous Application Made: (if yes,date--------------- No New Construction: Yes U?No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i <br /> (No septic tank or cesspool permitted if��iiublic sewer is available within 200 feet.) f <br /> Septic nk: Distanceafrom•nearest weilll-�_4L'f--__Distance from foundation_____��.........Mat�rial_--- -------- - <br /> No. of compartments____ --- Size--- X 5 ...9.:...Liquid delath-----�`- ----------Capacity-•W-•--•G <br /> Dispos Field: Distance from nearest well._ __-W___Distance from foundation....,f4_________-Distance to nearest lot line...... ..... <br /> Number of lines.._._ _ --3_____ ___________Length-:of ea!h line k-.__-___-_-__-�______-Width of trench.______ 2__�__-___...__..__. <br /> P Type of filter material- ,,N4_G-�aettDepth�of filtRr maf'rial______/�- __�. Totai length_________________hd.___________f-.__.. <br /> See a it: Distance to nearest well-___ B-l_----___-Distance from' oundation__--_1C..._.___.Distance to nearest lot line__�____-___-: � <br /> Number of pits_-___ !_____Lining material-F, A :Size: Dia meter_____.32_ ..........Depth____-ZS~---------•--------•- <br /> Cesspool: Distance from nearest -------Lining <br /> from foundation--------------------Lining material........................ <br /> Size: Diameter............... __ Depth*--":'*---------- _. ( -----------------------Liquid Capacity gals. <br /> Privy- Distance from nearest well__________________--________-I__-___._.__-_ Distance from nearest building-------------------.-_..._______________-. <br /> ❑ t <br /> Distance to nearest lot Ione------------ ----------------�-------------� �------------............ <br /> - ..-.. <br /> _ <br /> Remodeling and/or repairing (describel:______"*"_'�"" """""` —I I! <br /> ___ _______________._-__________-_-_-----F-----____________________________-____________________---.._.------------------------------------ <br /> ------------ <br /> i <br /> ------------------------ <br /> ----------- <br /> T... <br /> . 9 --------------. <br /> �� <br /> 1 Hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a <br /> ordinances, State laws,/pd rules and regulations c f the San Joaquin Local Health District. <br /> (Signed)--_—- P�________ __ __ 1 ' ---------------------------------------------(Owner and/or Contractorl <br /> By: ' . ) -....(Tit e)- <br /> (Plot plan, showing size of lot, location of.system.tn relation to wellsi-buildings, etc., can be placed on reverse side). <br /> ' FOR`DEPARTMENT USE; ONLY <br /> APPLICATION ACCEPTED BY-------------- _21-11----------------------------------------------------------------------r I � DATE........ <br /> � <br /> . v,� 4 I -------------- DATE------•------••---------- - <br /> BUILID NG PERMIT ISSUED <br /> ---------------------- -------- -- ------------- -------------------- <br /> SSUED-----------------------------------------•-------------------- [ ------------ DATE-----------_- ------ <br /> Alterations and/or recommendations---------------- ------------------------------ <br /> p:_ - r--------. £-(---------------------- ------ •---- ----•-`----- - <br /> °�s�"�~•---lira�_ -- - <br /> :W- <br /> ---------- . w .� <br /> --------------------- - -------------------- ------------------------------- ------------------------------------------•-------------------- ----------------- <br /> ------------------ ­--•-------- ------------------------------------- ------------------------------------------------------------------------•------------------------------------------------------------------ <br /> FINAL INSPECTION BY:.-- --------e ---------------------- ------ -- ---------- Date------------f0 •-02.7-6's <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak SrrNt 124 Sycamore Street 205 Most-4th_s reef , <br /> Stockton,California Lodi,California - ►; Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-52 ATLAS <br />