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------------------­ <br /> Permit <br /> jow <br />--- -- --------- ------- --- <br /> Permit No. .. ..,t� .. . .o <br /> f-1.13---.__-- JAPPLICATION FOR SANITATION PERMIT �---_---- -_--------- - (Complete in Duplicate) Date Issued ._/0�_/C_..--.J------------- 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 herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION____ ____ '�A <br /> Owner's Name-------,1�--------- 4 /.. �?< �/.y�✓ ----- ---- Pho -- <br /> Address__.....----•------------- - - ld.=�'-�.--------------------------------....................................... <br /> --- -0----�-�,-- <br /> Contractor's Name--.-..-�_­A <br /> -------- --•--••--------------••-•----•----..----------------•-•-•---------.._.-_. Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: __ ---- ber of bedrooms Z� Number of baths /... Lot size _,� _y ,l- -- ^_______________________ <br /> Water Supply: Public system Community system ❑ Private E] Depth To Water Table Wlft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No [;J..- Vew Construction: Yes ag-No ❑ FHA/VA: Yes ❑ No Q-5w, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan Distance from nearest well ---------------Distance from foundation__4...�_-.Ma tial--- .C. _ lC. <br /> No. of compartments-._--_-Size-__sr6_y-- ___Liquid depth__. r`2.----.-..--Capacity _;­ <br /> Disposal <br /> -_-. <br /> Dis osal Fi : Distance from nearest well---,. -_--_Distance from foundation._ _ A_�_._..Distance to nearest lot line__.......... <br /> p�d Number of lines......... I----- .-.-Length of each line------ <br /> �4.//-�-__`--_-_-Width of trench.c�_�_ _______________ <br /> Type of filter material-_-' _P_Depth of filter material_-_--�_(,f_------__--Total length-----��A------------------------------ <br /> Seepage P- . Distance to nearest ell-_?'---_---_-_Distance from foundatiop/Q_ ........Distance to nearest lot line__!457_j..... <br /> EA <br /> Number of pits------ --------------Lining material-_1�®.C- {'-Size: Diameter__. ---- ....Depth_�,rS�/.............. <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------------------------------------------ <br /> MDistance to nearest lot line.-.--.----------------------------------------------------------------------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe):------ --------------- /-�' ----•-- - ---- --•---•-•--•--•---- <br /> -----------••----•-------•----------------------------------•----•----•-•-•-•-----•-•----------------•-----------------•----------•-•-•----------•----------------•----•----•-•------------•-••--•••-•--••----•------------ <br /> -------•---------------------••--------------------------------------•-------•--------------------•---------------------------------•--------------•--------------------------------------•--•--•-------------------------•- <br /> I hereby certify t I have pre ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, a d rules n gulations of the San Joaquin Local Health District. <br /> 1" -_--.Owner and/or Contractor <br /> (Signed) r ------------ - ( / ) <br /> __-Title � --------- ------------------- <br /> BY:--------------------------------- ( ) <br /> (Plot plan, showing size of to , I cation of system in relatt to we s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY cy <br /> APPLICATION ACCEPTED BY--------- -------- -- <br /> - -- ` -�\ �------------------------------------------------ DATE----- 1.. _U- ----------------------- <br /> REVIEWEDBY---------------------------------------------------------------------------- ------------------------------ ---•------- DATE-------------------------------------------•--------------- <br /> BUILDINGPERMIT ISSUED-------------------------- ---------- .DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-_----_--g _-_-Z ------ �`���=----- ----_�`L '` "2 �*-- d ------•- <br /> -•-------------- -"-- 2 ._ � ------! ----•- ` ------- � /1 --t-: ``x' • =j �.._�•_ <br /> -----------------------------------------------------------------------------------------------------------------------------------------•------•--•-•-----------------------•--------------------------------------------- <br /> -----•----••••-•----...-•--•----•------------------------------------------------------------ ------- -----------------------------------------------------------•------------•--------------------------------------------- <br /> ------------------------- ---------------­-- ---------------------------------------------------------------------------------------------------------------------------- ---­----------- <br /> FINAL INSPECTION BY: L - <br /> --f3OO <br /> t -== Date = <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street We <br /> Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California" Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-62 ATLAS <br />