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APPLICATION FOR SANITATION PERMIT Permit No. . ... ............... <br /> -------------------------- ----------------------------- (Complete in Duplicate) <br /> ------- -------------------- ------ This Permit Ex ires 1 Year From Date Issued Date Issued ..__.. G__. ..� <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. E <br /> i1 �f--5-6 a 4. ir-f t 4 y 4 1 <br /> JOB ADDRESS AN LOCATE N_ .`7?7i - --Q � i7 ., <br /> Owner's Name__--_- � " °" /.r <br /> ,r. --- -`---- --- <br /> rC1fLJl _4L-L- ---- }lone ... <br /> Address iQ ` �. �/9` � <br /> Contractor's Name. ����✓. ----- --I--- Phone <br /> 4f <br /> Installation will serve: Residence Apartment House E] Commercial [3 Trailer Court..E I -Motdl' <br /> Y Number of iivina units: Alim[,ar of F,a.arriTme _49 _..-i L_iL_ / 4, /7/�eit­wI i <br /> Address lS—/I� k) 4 A.1rf,F 1 u city <br /> -••••• _�' 11 ,u a aoprn OT 3 TOOT-. Sana I__l Gravel U. Sandy Loam ❑ Clay Loa?h'❑•"Clay•0 --Adobe'@2;4'�H iirdpan ❑ <br /> Previous Application Made: (If yes,date__ -------------) No U-j"New Construction ,Yes ❑ No g-` FHA/VA: Yes ❑ No R <br /> TYPE OF INSTALLATION AND SPEC IFICAT1dNS: <br /> �I 4^ �'f. •a <br /> (No septic flank or cesspool permitted if public sewer is avaiiiabie wi.thin 200 feet.)-! r <br /> Septic Ta k: Di`s+ante from nearest well-- f--_ -.,pistangs,f�o�-{oundtion--- _ V- <br /> y��+1r <br /> .,.,.--...-.-.I_o._of.compartmgnts -- --- ---{ Size. _:. Liquid depth /.`------..Ca aci <br /> p +y ------- <br /> pisposal Field: Distance from nearest we]l__ / Distance from foundation.. _`` __ Distance to nearest lot line. <br /> Disposal <br /> Number of lines__ ----- � _ Length of each line, , ./ i�_�Width of tench�"'+ �__.:'________-._•___-__�I <br /> Yp� filter material. Depth of filter material..V�----74-------Total; length,-__3..0 - <br /> �i i <br /> See a Pit: Distance +o nearest ell____ ' o �� Dis ante to nearest lot line.' <br /> ,� �=---Distance fr m-foundation---- -- ---------- ---_..._. <br /> .Number of pits__.._______-__Lining material_ W' ' <br /> , �e.___.Size: Diarnefer__20e.V'--- th__ �' �_- <br /> ;,.,.:. . T P -- <br /> Cesspool: '- Dista etfrom nearest well_________________Distance from.foundation_._.---___.___.,__-.Lining material-------------- <br /> -.•-----•--- <br /> ❑ Size: Dierneter--------------------------------------Depth---------------------------•----------------- -----Liquid Capacity gals.) <br /> --------••- <br /> Privy: Distance`from nearest well-------------------------------------------------Distance from nearest building__________________________ <br /> 0 Distance to nearest lot line____________ 1 <br /> Remo�ing anvOr rope' •ng {des ibe�:----- '--0-��.w j •-•------A40- --_-..._ of / <br /> !' L <br /> i <br /> p�" - •-- -------------- <br /> - <br /> •----- ------------------ ---------------- <br /> -------------- <br /> �. <br /> ------------ <br /> A7 r" <br /> - --------------- <br /> •----------------- <br /> ----------- <br /> ------ <br /> '-- slyri <br /> Pd_ ter- ! - <br /> � '. <br /> hereby certify t(1at I have prepared tis appiica+ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules- <br /> les-and regulations of the San Joaquin Local Health District. <br /> (Signed) --- --- - ----- -- - • --- ----------------- ----------------- - - -- - ---------------- - <br /> ---• ----------(Owner and/or Contractor) <br /> - <br /> By:-------------------••-----------------••------------------------- °� (Title)--- <br /> -a - <br /> ---- -- ------------ <br /> (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). <br /> I - <br /> j FOR DEPARTMENT USE ONLY <br /> !APPLICATION ACCEPTED BY-_ _.._ .„ ..... <br /> DATE_. 1 _.-.w <br /> fiEVIEWED BY - DATE <br /> ----------- -------BUILDING ----------------- <br /> PERMIT ISSUED-------•- ----------------------------•-•-•--------------------------------------------------------------------- <br /> DATE-------------------- <br /> AlFeratioand/or rete me d'ations ------------------- - 3;�� ------ <br /> ------- ---- <br /> 1. <br /> - --------------------------------- ......­­------------­--- y <br /> FINAL INSPECTION BY:-------- <br /> r.__.. _ Date_ .- - <br /> =----- / t -------6----I z-------------- - <br /> SAN JOAQ.Uk`LOCAL HEALTH DISTRICT <br /> 130 South American Strut # 300 West Oak Strut 124 Sycamore Street <br /> 305 West 9th Street <br /> Stockton,California Lodir California Manteco,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />