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------v------------------------------------------------ AP"`CATION FOR SANITATION PERK Permit No. ...._-Ab�l <br /> ----------------------------- --------------------------- (Complete in Duplicate) , <br /> Date Issued <br /> ------------------------ -------------------------------- This Permit Ex fires 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 herein described: <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION. _1- _ .- G.} <br /> ...�?rl_g, -E+------------- e, ... <br /> Owner's Name------ [1'�1~ - e <br /> G-v.- Jav---� •--Q;- ''� -'a=�----�'� -------------------- Phone----..�..�':.--��•�--�- <br /> Address -s ` <br /> ''-`-(�---h--------------- -------------- <br /> ------------ f - <br /> Contractor's NamW� iJ�a Phone,. _.....4��i'-�.�.. ��. <br /> Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ nMMotel ❑ Other ❑ <br /> Number of living units: __I____. Number of bedrooms _f __ Number of baths ....�.__ Lot size ......o_.�'4-tA_1-/... .. <br /> Water Supply: Public system I] Community system ❑ Private U4--Depth to Wafter'Table _1-S__ ft. {�' <br /> t:1%arae4ar n; cnil +n a r4PnA nf3 p_ef' qarlC4, GcRUP-lD �[l[li�Vl.C1i'1m1J S.l v tis I7�W Sr V� .A Lj �'123i � <br /> Previous Application Made:(If—yes,-dote---------------------) No <br /> Construction: Yes ©rNo ❑ FHA/VA: Yes ❑ No 0' <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 /> -. LgOG-.•j No. of compartments-----------•--------------Size----------••--•-------------=---Liquid depth-------------••-----------Capacity....................... <br /> Disposal Field: Distance from nearest well___ __________Distance from foundation....-.--------------Distance to nearest lot line______•_--------. <br /> Number of lines-----------------------------------Length of each line-----------------------------.Width of trench-----------------.---- <br /> d Type of filter material-------------------------Depth of filter material--------------------.__Total length-----------.................--------_-__-- <br /> Seepage Pit: Distance to nearest Distance from foundation....1A_r______..Dista to nearest lot __�,[ine1...... <br /> [97 Number of pits......1_____________Lining material__&H _____.Size: Diameter-_- " �� Depth__-�.�?1•�=�.__ <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----------------__.Lining material--_.____._..___--._....-..-_.______•_ <br /> ❑ Size: Diameter--------------------------------------De th--------------------------- <br /> P ------------------------Liquid Capacity-•---....--•-------•--...--gals. <br /> Privy- Distance from nearest well_________________________________________ _______Distance from nearest building-----------..------...________.__________- <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------- �--_A L1 � !� �J-----•-—' ----------------- <br /> ------•---••--------------------------••------•------------••--------------•-•-------•--- -------------------•-----------.......-----------------•----•--•-------•--...--------•---.-------------------------•---- <br /> I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> •(Signed)`,,l_- . ---_---- :.._:}.•``� " -j .. K.---------------------------------------------- (Owner and/or Contractor) <br /> By:..:......__ !1! .- } �`'` t`�� ----------------------(Title)--- <br /> �t-(--7'--..-. .. <br /> (Plot plan, showing size clot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> -�-- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------f F----- -------------- ------------------------------------------- DATE------------- rte_' '--------------------- <br /> REVIEWEDBY----------------------------------------------------------------------------- ----------------------------------------------- DATE.. <br /> BUILDING PERMIT ISSUED---------------------------------------------------•-------------------------------------------------- DATE.---------------------•- <br /> Alterations and/or recommendations---------------- - -----------------•-------- ------------------------....-•------•----------------••-•------.-------... <br /> --------•----------•----. ­--- <br /> -----.. -. --- ----- --•-•--- <br /> 1 <br /> ----------------------------------------------• - �. = -----------------------•------••-------------------------------------------- ------------..-..------ <br /> �-� _.. <br /> --..--•--------••-------------------------------------------------------------------- <br /> FINAL INSPECTION_Bx,_ � �-'� <br /> Date_ C� 1 -�- -r��----------------------- <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,Californla Manteca,California Tracy,California <br /> E6 9 REVISED B-89 $M ',,-41 ATLAS - <br />