|
FOR OFFICE USE; r
<br /> APK K. 'ATION FOR SANITATION PERMIT Permit No. ... ......:.. .....
<br /> ' (Complete in Duplicate)
<br /> 1 ` Date Issued __
<br /> -- - - i This Pormit Expires i Year From Date Issued
<br /> Application is hereby made to t^'e Sar J,,a_ji^ Local �lealih District for a permit to construct and install the work herein described.
<br /> This application is made in compharnce wi!r� Co,;rty Grdinance No. 549-
<br /> c
<br /> JOB ADDRESS AND LOCATION... -79eA. - .P41-k' 'f}�C7.-- .. . - ------- - ----------------------- ----------------------- ------
<br /> Owner's Name_ .. .. Al 4,'
<br /> Address---------------------- ------
<br /> Contractor's Nams r /x7.t-J 2,!P/_ / _.., f'�'lY � �'-- --------------------------------------------. . �.� f _-
<br /> %7_
<br /> . .-------------- Phone. --- --- - --
<br /> Installation will serve: Reridenr'.e Ala-rnen+ House ❑ Comr;iercial ❑ Trailer Court ❑ Motel ❑ Other ❑
<br /> Number of living umis: ./__-- Num�le bedrooms Number of oaths Lot size ------7-----Avrw=------......................
<br /> Water Supply: Publi.. y :r n`ri _ system Ej Private J�5' Dep+n To Wafer Table *- - ft.
<br /> Character of soil to a dep`.h of 3 feet. .,... .. U`dvei ❑ SSaandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑
<br /> Previous Application Made. ;,r e s,f'cto } NOF New Construction: Yes ❑ No 2-' FHA/VA: Yes ❑ No ❑
<br /> TYPE OF INSTALLATION AND SPECIF)Cv,ATIQNS: 1k,
<br /> y -
<br /> (No septic tank or cessDoof permit-iY xt pt.b is sewer is available within 200 feet.) v
<br /> Septic Tank: Dist tr(- e , D -ante from founda+ion- -- -- -- Material--- ---- -- ------------------------- -------
<br /> ❑ q�X I s?'�N� , uid de t� ........
<br /> p. ... ...... Capacity-----------------------
<br /> L
<br /> Disposal Field: lata oa e:A ,Ne E Distance from foundation ..... ..........Distance to nearest lot line-----------------
<br /> F-I co rime Num;er c _,_myth of each lire- ----- ---------------------Width of trench---......-......-..................
<br /> ,
<br /> Type o: ,i,tcr rT,a, r,:. - - sr'n 0t t,ter roanlength
<br /> Seepage Pit: distance fn t e:tres` �6+r ` - ^Cis+.ince from foundation____,�FC Distance to nearest lot line --
<br /> AOLD Number o nitsmateriai._ ;pSof.... SSze: Diameter.---_--3JF ........Depth...... ..............
<br /> Cesspool: Distance }rcrneoe;, We.' D s+ecce from foundation-------------._._..Lining material-____..-----------------------------
<br /> Size: Diamate- DE!ahh- - Liquid Capacity gals,
<br /> Privy: D s�� :_.e t a.a :. - ,, --- - --- - - Jis+ante from. nearest building................ ---- O
<br /> Distance to �ea � •�'" � .........
<br /> reS ...... ...
<br /> Remodeling and/or repai�i,7g ;des;.rioE;!: /90. --------------------------••------------------------
<br /> ------------------------- -- ----- ..._ .._. ... .._... . ... .. . ......... .. _. .. .... ............. ... .. ... ...... ------ --- --- -- ---- --- -----------------------------.
<br /> - --
<br /> --- ---
<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 and regulations of the San Joaquin Local Health District.
<br /> (Signed)-------.J_C-_zl- .,� e7.,4� �W,- 4,,n J✓ .. ------------------------ - - ---------------------(Owner and/or Contractor)
<br /> Ti ] . ..� ...-------- -------- ---- -- ------
<br /> BY:------------------ -�--.. .fes-�..�_ - ..- �--......... ........... ... _( tle_..._...� __._.
<br /> (Plot plan, showing size of lot, locati 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 /> REVIEWED BY _ - ---- ------ - ---- DATE ---- --- ----------------------------------------------
<br /> BUILDING PERMIT ISSUED... ----------- -- --------- DATE - ... ---•-_. .... -- .... . ---------- ---
<br /> Alt7r tions and//r recomm lotions �, _ --
<br /> -------------------------------- - - -- -
<br /> -- - - ---------- ---- ----------------------- ...... -------------- -----
<br /> FINAL INSPECTION BY:... L
<br /> Date..
<br /> SAM JOA� j!N LOCAL HEALTH DISTRICT
<br /> 130 South American Street 3GG Woe Oak sv.aar 5,24 Sycamore street 205 West 9th Street
<br /> Stockton,California L:.c r, ,t ,:, Marreca, California Tracy,California
<br /> ES 9 REVISED 8.59 2M 5-52 ATLAS
<br />
|