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rUltUr1-11-t ubt: <br />--------------------------------------------------------- <br />------------------ --------- ----------------------- APPLICATION FOR SANITATION PERMIT R� 1��ermit No. __1 __ <br />--------------------------------------------------------- (Complete in Duplicate) ��. i ZSR b-4 <br /> A• <br /> Application is hereby made+o the Sen Joaquin EHealth District <br /> f foroa e permit Issued" '" —"""'Date.Issued ....................... <br /> pp Y pe to construct and install theworkherein described. <br /> This application is made in.compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-.2-:3 .,6 ._S ASE .A -------------•-------- _----------------------------• ----•--......................... <br /> Owner's Name..._._.3.t?►Ck-----•-:.L_ALLA€,e----m-Ax--------••---------------------------------------•--• PhoneA+ =-n.q <br /> Address---0710..... �.(.A_�� - � <br /> -, <br /> ContractorsName------X70......?�.i'.gE.k..-----------------------------------------------------------------------•----............... Phone................................... <br /> Installation will serve: Residence ®, Apartment House ❑ Commercial-U Trailer Court ❑ Motel 0 Other ❑ <br /> Number-of living units: ....._. Number of bedrooms A--- Number of baths Lot size _•IC�.Q`___�.�.�.�.�?........................ <br /> Water Supply: Public system [] Community system —Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand I]Gravel 0 Sandy.Loam❑ lCiay Loam Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date_9-_�_-.bA__) No ❑ New Construction: Ye,k No ❑ FHA/VA: Yes ® No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if-public-sewer-is-available-within 200-feet. <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation_______........._:_.Material...____.___...................................... <br /> , <br /> . <br /> E'Q5E11+1y No. of compartments----------------_-------Size--------------------------------Liquid clepth!-------------------------Capacity----........ ----- <br /> __ <br /> ! f <br /> _ I_&:.Distance from foundation.-.l 0_ .Distance to nearest lot line.... <br /> Disposal Field: Distance from nearest well-YID ......... <br /> -Kj S Number of lines------I_A------------------------Length of each`•line.------Ste_-_-.---.__a.Width of trench-------�.4..------------------ <br /> dd Type of filter materials j;_C-__t�k Depth of filter material..._._I.4___-0-d-Total length--- {...:.-------••-----__--_. <br /> T <br /> Seepage Pit: Distance to nearest well______________ ____Distance from foundation----------------- :Distance to nearest lot line....._________-- i <br /> ❑ Number of pits-- -- -------------Lining material----------------•------Size: Diameter.—.-*-----------------Depf h-------_----------------------- LIQ <br /> Cesspool: <br /> iametef :f...-.-----------.Depth--------•-•----•----•-------- <br /> Cesspool: Distance from ne'a'rest well_________________Distance from foundation--_.:____:_t—____.Lining material------------------------------------- <br /> 13 __._❑ Size: Diameter- ------------- -------------------Depth------------------------`=: -• ------------------ Liquid Capacity_-------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ <br /> Distance <br /> __-______--._,•_____-- -----,Distance to nearest lot line----------------------------------------------------------------_--_----- <br /> Remodeling <br /> • `-Remodeling and/or repairing {describe} __.._ 1_---- ______ _ $�,�A`+ _ 1 <br /> -------------------------------- y[ <br /> ............................................•.______.___.. 9_ _ ---- -------------------i ....--------------- <br /> __________-•---•--________ <br /> ----------------­---( -�--------------------• -------------•------------------------- f <br /> I hereby certify that I have prepared this application and that the workJwilii 9 done in accor"dance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (signed) . ... i---- --------•----------------------------------------------- --------- x <br /> 1 (Ow�e'r-and far Contractor( <br /> j <br /> BY:.......... ..��(/_ f Title -Af 1 <br /> (Plot plan, showing size .,of lot, location system in relation to wells, buildings, etc `can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------C,.... <br /> 5 ---------------------------------------------- DATE 1-Z sf— 4a-�.. <br /> REVIEWED BY -------•--•-----•------- ( -------------- :-------- DATE <br /> ---- <br /> BUILDING PERMIT ISSUED..................... ------------------------.------------•----------------------------------------- DATE---------------------# ' <br /> Alterations and/or recommendations:.----¢---------------- -------------- ----...---•....------------------------------•-----•-•-- ~ <br /> -•--------------------------••---•-•-- --•-- <br /> ------- <br /> ------------------------------ <br /> ------------------_ <br /> ------------------------- -- <br /> -------------------------- <br /> ---------------•--------------------- t <br /> FINAL INSPECTION BY:-----e ' = -------------------------------- Date-71777:$==�o - <br /> -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street , r 124FSydrmori Strait '=e 205 West 91h Street _ <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ER 9 REVISED 8.59 2M 5.61 ATLAS ]+ <br /> -� -f <br />