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FOR OFFICE USE: <br /> --- - -- --- -- -- - !!Qy� LL <br /> __-_-------_- --_..-_.-_.--------_-----_------_--- APPLICATION FOR SANITATION PERMIT Permit No. ._�f/-3-1.-.9 <br /> (Complete in Duplicate) SFANNEMIssued <br /> ----A--.._----------------_ This Permit Expires 1 Year From Date Issue .„.....__b �.-.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describecL ? <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO ION1 ! ,ppL vlr�+n._t_.Gf.rnrrrr=-''nF--------------- R�_-.................................................�� <br /> Owner's Name--------- 1.._-. - - - - Phone...... - -- <br /> ,pp / --------------------------- ----- <br /> Address-------------[.tQ--_3 y...... ........ s.- / -------.._-------------------------------------- .___-_.___.__-...-_-___..___.-..--___-__..-..__------ <br /> Contractor's Name---- ✓i�crYta4 ------------------------------ --------- Phone----------------............. <br /> Installation will serve: Residence [�r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms 3---. Number of baths _1------ Lot size fl_2--'''/-`1-7.o-.....--.-----.-------- <br /> Water Supply: Public system ❑ Community system ❑ Private [) Depth to Water Table/-4-P_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.® Clay Loam ❑ Clay ❑ Adobe p Hardpan ❑ <br /> Previous Application Made: (If yes,date ) No ® New Construction: Yes [H 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.) ,,.���� � 77�� <br /> Septic Tank: Distance from nearest wellsrb.:__ �---_Distance from foundation_� .---._-_--Material_A ^.:4_----- -_-.----__-. <br /> WNo. of compartments__r.2----- ------------Size!_yt.tff'-L, _--------.Liquid depth-----Y__--------------Capaciiyt,?-0-P_---_----- <br /> Disposal Field: Distance from nearest well.�d-------Distance from foundation.._S`....... Distance to nearest lot line._ <br /> ---- I---------- <br /> 91 Number of lines----- <br /> y ---_ -- _- --- Length of each line-----_-----___-_-___--.-.Width of trench 34_"----*-.__-------._ <br /> Type of filter materi i41_Depth of filter material.__/ -------------Total length-._J�.9.......-_.-_._-___--_-----. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation.._-------------...Distance to nearest lot line._._-_---._---. D <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth___._...._____-----------_. <br /> Cesspool: Distance from nearest well--------------.._Distance from foundation_-----------------Lining material-----------. ---------.......... Ip <br /> ❑ Size: Diameter---------------------------Depth-------------------------------------Liquid Capacity---------------------------gals. N <br /> Priv Distance from nearest well_-__-.-_____-__---__-_--------------Distance from nearest building- 0 <br /> Privy: <br /> — -------------------------------------- 'A� <br /> ❑ Distance to nearest lot line._.--------------_---.---.----.'_..._...----..-....-.'---_---'--. <br /> Remodeling and/or repairing (describe):------- ------ --- _--------------- ---- --------------------------------------------------------- T <br /> - -----------------------------I----------- ----------...------- ------ ---------._...--------------------------------------------- ------ - ----------------- -- <br /> ------------------------------------------------ <br /> . <br /> -- - -' --------------------------------- ---------------------_------------------------------------------------------------....... ._---------------_-------------------------------------------- <br /> -- -------------------------------------------------------------------------------------------------------------------------.. ­_­--------------------------------------------------------- --- <br /> I 3 <br /> hereby certify that I have prepared this application and that +he 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 /> (Sign edJ--y 'C -------- ---------- -----------_ ----.........---------- -------------'-------------------'----. (Owner and/or Contractor)9� <br /> By:-------- ---------------------------------------------(Title)--------- -- <br /> (Plot plan, showing size of lot, locafion of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYe0_10”___ _� - ------------------------------------------------ <br /> j -- - DATE..L#� . <br /> _ -.�D---------�. ------- <br /> REVIEWED <br /> ----REVIEWED BY--- --------------_--- _--------------------------------------- ----------------------------------------------- DATE-------------------------.........-- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------—------------------------ - ---- . DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:..... -_-------------------------------- - ------------..-_....-----------------------___---------------------------------------------- <br /> ---------------------------------'----------------' - -----'--.. ....---------- <br /> -----------------------_...----------------­--------------------------------------------._---_ --------------------------------'-`--------------------------------------------------------- <br /> FINAL INSPECTION BY:,e---- g72rt.L1- --------- -----.... . Date--- % —wl_-- - -- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha..lton Ay.. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> ES 9 REVISED 9-55 3M 3-'63 F.P.CC. <br /> r <br />