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FOR OFFICE USE: <br /> 26 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- <br /> -------------------------------------------------- (Complete in Duplicate) <br /> Date Issued ------ <br /> ------------------------ ---------- ------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he.rain described. <br /> This appii6aition-is,-made'in compliance with County Ordinance No. 549. <br /> ......... <br /> 14 <br /> ..:.: , T <br /> JOB ADDRESSIAND LOCATION . _e ....... /&eow�w---------------------------------------------- <br /> Owner's Name-----t xlolvlle...........(, C <br /> Address ----- - 4- ;n.. ...... -------- -------------------------------------------- Phone.............. -----------_...... <br /> . ...........*--------------------- ------­------------------------------------------------------- <br /> ................... <br /> ------------:,*--------------------------------- <br /> 5" 7 IJ19 <br /> Contractor's Name--------1 D- 14 F_�- . .... . 0,= 7� <br /> Installation will serve: Residence'K Apartment House [] Commercial F] Trailer Court [] Motel G3t; Other ❑ <br /> Number of living units: ___1. Number of bedrooms ---.2-Number of baths J--- Lot size ...... ------------•---•-.•.-•.•- <br /> system[] <br /> Water Supply: Public system <br /> Community SySte . 'Prk;ate ❑ Dep+h-jo Water Table ,!neq ft. <br /> ❑- " - J� ' -- <br /> Character of soil to a depth of 3 feet:-Sand El -Gravel E]., Sandy-Loam Glay'Loam Ej Clay Hardpan AdobeA!r ❑ <br /> i; I <br /> Previous Application Made: (if yes,dcite-.------------------) No New Construction: Yes No FHA/VA.. Yes 0 NoO <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:— _1 151 1- 1 <br /> (No septic tank or cesspool pef'rniffed if public sewer is available within 200 feet <br /> i <br /> ePTLTs k, Distance from nearest well-j--------------DistanCer.frorn foundation--,,----------------Mat'erial------------------------------------------------- <br /> No. of compartments------------------------Size......... ---------------------Liquid depth--------------i---------..Ca aci ----------------------- <br /> Dispo al Field: Distance from nearest well:'______.___._'.Distance_'.Distance from 4ounclation.."-----------------Distance to nearest lot line................. <br /> Number of lines---I----------- ----------:-------Length of each line..............................Width of french----------------------------------- <br /> 6i 1 s__.-._-_--_I . . It -----------------­ X <br /> Type of filter mate'rial._._._"�--- ------------Depth of filter material____. - ----Total' length----------------------- <br /> pit NS <br /> AePepa Distance to nearest well_._AkA)S,,__.Distance f[-W founclation-'/V..."..-..Distance to nearest lot line <br /> I Number of pits..... Lining.material-t--- Size: Diameter_ Depth_ ----------------- <br /> X/4vt• <br /> Cesspool: Distance from neare&O-w6ll------------------Distance fr(jnvfoundafion___._r=1------L­Lining material...____.....________.._....--........ <br /> -----------Depth--- - k <br /> Size: Diameter----------- --------- ---- - -----------------------------------------iL.-Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------!------------- Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line--------------------- -• ---- --=-------- -------- -- ------- <br /> Remodeling and/or r 'Aleek....../ <br /> repairing (describe) ........ Z-----------77 ------------------ <br /> ----------- <br /> --------------------------- <br /> --------------------------------------------- <br /> ---------------------------------- Ele_�--------------------------------------------------------------------------------------------------- <br /> ----_------ <br /> ---------------------------•--------------•-•----------------------------•-------•---------------- --:----------------------------------:­----------------------------------------------------- <br /> I hereby certify that I have prepared this..application and that the..work-will,be--done in accordance with San Joaquin County <br /> ordinances, State laws, and rules I regulations of the San Joaquin Local Health District. <br /> (Signed m7/511, IV- U,/ - --7, !. , <br /> ------------------------------------.-.-(Owner and/or Contractor) <br /> .......... <br /> By:.........................•----------------------------------...... -------- _.1Z------------------{Title)------ ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -�__ ---------- -------------------------------- DATE-------- -------—----------- <br /> REVIEWEDBY-------------------------------e...• ......-----------------------------_ ------------------------------------- ............. DATE...................................................-------- <br /> BUILDING PERMIT ISSUED-------- <br /> ----------------------------------------- DATE--------------------------------- <br /> Alterations <br /> ATE---------------------------------Alterations and/or recommencrations:.-7.--/-I'--.6-;---:--- <br /> ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ .......---------­- <br /> ............I....................................................------------------------------------ ---------------------------------- ------------------------------------------------------------------------ <br /> ------------------------------1­-------------------------------------------------------------------------------------------------------------------------------------------------------­---------------- ................. <br /> ---------------------------------- .......... <br /> . ---- ------ -------- --------;::--------- -------------------------------------------- <br /> FINALINSPECTION .. . . -- -- ------------------------------------------------------ -Date------------- ---—------------------------------- <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 Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-61 ATLAS <br />