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APPLICATION FOR SANITATION PERMIT Permit No. ..l .f__. .. !. <br /> (Complete in Duplicate) �� <br /> This Permit Expires 1 Year From Date Issued Date Issued ........ ��4_.. <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 Ordinan a No. 549. <br /> JOB ADDRESS AND LOCATION_ t--------•�----------------------------- <br /> Owner's Name---•-----•--J71:/ RI_ _--- Wp /'�Q.,��----------—•----------- yr` v, Phone <br /> Address t�-e?D �7IM ,:�I'•_,•----•Ixl.!�-�.'--=---•--..... ...--, <br /> Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone................................... <br /> Installation will serve: Residence;g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> If <br /> Number of living units: J Number of bedrooms 192--- Number of baths _/_.. Lot size 4 .1_0_............................ <br /> Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 5.90 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ 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 fee`.) ,,// AA � , <br /> Septic Tank: Distance from nearest well;R—AiMistance from foundationeVAIA(_fMaterial__L._�_(,�_.j&—Y�.__-_.___---.-. <br /> Do No. of compartments--------------------------Size--------------------- ..........Liquid depth--------------------------Capacity---1?10Q---•-- <br /> .,i . <br /> Disposal Field: Distance from nearest well-yQOt_Distance from founclati n lklt _.Distance to nearest lot line.u,pl_ my <br /> PNumber of lines--_--__ Length;of each line__-_00--------_----------Width of trench____c ___ _ / <br /> Type of filter mate ria _-__Depth of filter material--/#'--------------Total length......_.... ..-_,.____..-.---_-.__... <br /> Seepage Pit: Distance to nearest well--/_V*9tI Distance from foundation.&*tXZ1Y.DistaL ce to nearest lot <br /> ® Number of pits-----/--------------Lining mate rial__X_P.4&---Size: Diameter_.•' ---------Depth-_- '0 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-----_.-__----_-.--_-----.-..-..-_-- (� <br /> ❑ Size: Diameter----- --------------------------------Depth----------------------------- ----------------Liquid Capacity---------------------•.-----gals. <br /> Privy: Distance from nearest well---------------------------------------------------Distance from nearest building------------------------------.-_-_-_--__. t <br /> ❑ Distance to nearest lot line--------------------------------------------- --------•-------•-------. ---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe----------/'1•/��� <br /> --- �------ f sx.6- =-�-47---•----------•------------•-------------------------------- <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) {� ,, / <br /> ----------- ------------------------------ j /or Contractor) <br /> ------------------- --•---------------(Title)--- ------------- - ------------- <br /> (Plot plan, showing size of lot, location of m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------�_ _'--------------_-__-_--- <br /> --------------------------------------- DATE----------�..:�.��- .--` ------- <br /> ------------------ <br /> REVIEWEDBY------------ ------- -------------- ----- - DATE------------------------------------------------------------ <br /> U PERMIT ISSUED- �'_►-r--- - � ©-`� -- DATE ---- Fr <br /> Alterations and/or recommendations:.......P4&1�.-_-.____�HA-�6�D---_-.-.. --..___ T �_..... iv..__. t_�. <br /> . L --------AVr8 r -----Q�-----ga./..---------�; ---t--`I-� r �,-------------------------- ------ <br /> ------------------------------- ----­------------------------ ----------------)---P,.f)..................................................... ------------------------------------ ------------------ <br /> ----------------------------- ------------------ 1- --- ----------­--- -(_I---------------- ­-------------- ---------------------------------------------------------------------------------------------- <br /> FINAL INSPECTI - -- -------- ------ -- -- Date------- ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. <br />