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I1-j",%.jI IILC UZIr: <br /> ------------------ --------------------------------------- <br /> ------------------------------------- ------------- kPPLICATION FOR SANITATION IMIT Permit No. <br /> _( 2f E------------- (Complefe in Duplicate) <br /> --------------- <br /> �j.;/ c_ tC <br /> ----------- This Permit Expires I Year From Date Issued 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-_--&.c il_ d <br /> ..........CO.Al <br /> Owner's Name-------- ................................................................................. <br /> ------- ------------------------- Phone*,0-4-YJA.f <br /> Address----- --------- <br /> Contractor's Name.___. --- <br /> -------------•-------------- <br /> Contractor's <br /> ------------*-------------- <br /> "V...... .............................................................................. Phone.Z,4::�e?/"�........... <br /> Installation will serve: Residence [I Apartment House [] Commercial [I Trailer Court [] Motel [] Other 10 <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ........��V IVAN A 9 1,e,Y ctwt, <br /> ............................................... <br /> Water Supply: Public system E] Community system El Private [2 Depth to Water Table ........ ft. N Pe,4 T <br /> Character of sail to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam E] Clay Loam [3 Clay [I Adobe[I Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date--------------------) No El New Construction: Yes 4 No 0 FHA/VA: Yes El No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SAptic Tank: Distance from nearest well____ Distance from foundation./e.1......... 7 61/y C- <br /> No. of compartments--------3----------- ---------------------------------- <br /> Disposal Field: Distance from nearest well--,-5'0 11 __Size.31X__4�:�---LC...Liquid I depth--------y-------------CapacitywR �Al_ <br /> -------Distance from foundation...Ael............Distance to nearest lot line................. <br /> Number of lines----------------_2---------------Length of each line....L-3_0-------------Width of trench-----37-K-------------------- <br /> Type of filter material---&?_!4--------Depth of filter material------Zf----------Total length.... <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation....................Distance to nearest lot line................. <br /> 0 Number Of pits-"_-__."--------------Lining material_-__-.-__-..---_-------Size: Diameter"_-_----_."_--.-_. .----Depth--------------------------------- <br /> Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material_......_._......._._........._....... <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------"---._.-._.._.___- -------------Distance from nearest building-___-"-"-"_--__--__---------___._----_-.-. <br /> ❑ Distance to nearest lot line---------- <br /> Remodelingand/or repairing (describe):"_____________"-..-___.--,._--__.._------------------------------------------------------------------------------------------------------------------------ <br /> .­_­----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---­-------­------------------------------------------------------------------------- <br /> cation and that the work will be done in accordance with San Joaquin County' <br /> I hereby certify that I have prepared this appli------------------------------------------------------------------------------------------------------------------------------- - <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------- : <br /> ----------------------------------I------------------------------------------(Owner and/or Contractor) <br /> By:.....;;�... <br /> (Plot plan, showing size of lot, 6c�ffion of system in relation to wells, buildings, etc., can be placed on rave-rse.-side). <br /> FOR DEPARTMENT <br /> APPLICATION ACCEPTED BY <br /> REVIEWED BY------ .... .. . ........ <br /> T. j. ----- ----- DATE------.......- MV <br /> ------------------------------------------------------------------------------------------------------------------------ DATE ----I..or--- ------------------ <br /> BUILDING PERMIT ISSUED_________________------------------------------------------------------------------------------------ DATE................................................................. <br /> .......................................... <br /> Alterations and/or recommendations: <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ................------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .............................................................. -------------------- ----------------------------I--­---------------- --------- ----------- --------------------------- -------------------------------------------------------*---------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY <br /> ---­----------- <br /> z4 Date----- -------- <br /> SAN JOA91JIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> ES 9 REVISED 8-59 2M 5-61 ATLAS Tracy,California <br />