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FOR OFFICE USE: I <br /> a L� <br /> ------------------- <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... .l... .. . <br />------------------ --•------ -------------------- {Complete in Duplicate} <br />--------------- <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 /> 4 RYA o_S`x=mac . :; <br /> JOB ADDRESS AND LOCATION__ __ __W _ __I �_.--...2ic+_ _,<R. ----V •--aF--- ►- -- •- -- <br /> Owner's Name----- Comq------------1L►�-L-_H14�------ .. .. P-hone <br /> r <br /> Address--- -----------7"Q 84-T --f_-----------------------f-41 - - . --•----- ............................ <br /> .. = , <br /> Contractor's Name--�h�T±Iz ...... C- = R ---•--------•----•------------- :a <br /> Contractor's . <br /> I <br /> 4��fy�-2 Y <br /> Installation will serve: Residence (Apartment House ❑ Co-mrnercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ <br /> Number of living units: _2—. Number of bedrooms _rr�____ Number of baths -_2.- Lot!size ------------------------ <br /> Water Supply: Public`system.0 Community system ❑ Private �KttDepth to Water-rTable ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loarn,,PT�­Clay Loam ❑ Clay ❑""Adobe❑ Hardpan ❑ <br /> t- �No ❑ FHA/VA: Yes No <br /> Previous Applicatioe Made: (If yes,date__-..__________....) No VNew Const <br /> Pr ructlon:kYes ❑ ®f <br /> TYPE OF INSTALLATION IAND(SPECIFICATIONS: F��- f: ;,d ;fir t <br /> _. <br /> No septic tank or cesspool permitted <br /> if ublic sewer is available within Zoo feet.} <br /> { P P P11: %Aso.'I <br /> - _ dation---lC�__.._..__.Material_r]�t460,O.�------------- <br /> Q <br /> Septic Tank: 'Distance from nearest wel -_0._.. i ea c ° Liquid depth___.'�Y--------------- Capacity_1 ©� I <br /> [� No. of com artments______ L� <br /> Disposal Field: Distance from nearest well___-�,? .._Distance from foundation____ Q _____Distance to nearest lot line_... <br /> Number of lines--E------�--- ------------------Length of each line=-=' �t;-•-••--j-_-=-Width-of..trench------ ��. ---.-------- Q <br /> YYPe of fil#e t nal._._RD_CX_ Depth of filter material-----��.----------Total length........ p------------------- <br /> Seepage Pit: Distance to nearest well------ -------Z—Distance from foUndation....................Distance to nearest lot line.__--___________-; .� <br /> I '.. <br /> ElNumber of pits----------------------Liriing�m,�a-4arial------------------Size Diameter------------------------Depth---------------.-=-------------- O <br /> Cesspool: Distance from nearest well --------� Distance from foundation__------------------Lining material-----------------.----------......... . <br /> ; ~ <br /> ❑ Size: Diame#er------------•---- -----Z-----Depth-------------- ----- ----•---------------- •----Liquid Capacity----------_--------------gals. � <br /> Privy: Distance from nearest well.... ------_-----------------------------Distance from nearest building--------------------.__________.__-------.!x <br /> ❑ Distance to nearest lot line-- ----------------------•------------------- -----------------------...........-------------------------------------------•---------------- <br /> Remodelingand/or repairing (describe):-----------------------------------------------------------------------..--------------------------------------------------------------------------------- <br /> ----------------------------------------------__----------------------------------------------------- ---------------- -----------------•------------------------------------•--•----•------------------------------ — <br /> -------------•------------------•--------•----------•----•--------------------------_--_.--------------------•-•----------------•---------------------------------------------------------•-•------------------------------- <br /> ------•---------------------------------•-----------------------------....-------------••------------------------...-------------------- '`---••------..-------------------------------------•----------------- <br /> I herebyY certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County; <br /> ordinances, Slaws and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-I�" (- - --- -------------- L2/✓c..1.�� -------------------------------------------------------(Owner and/or Contractor)1.. <br /> By----------------------•-----------------------------------------------------------------------------------------------------------(Title)---:----------------------------------- - --- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> pp <br /> APPLICATION ACCEPTED BY------— ]-r® ------------------------------------------•------------------------ DATE-------�7.'� .' .------------------ <br /> REVIEWEDBY-----------------------•--------------------------------------------------------------------------------- ----------....... DATE------.-.---•-------._...-------._...._--------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------.---------•-•------------------------------------------ <br /> AlFerations and/or recommendnfiions::'�- -"" ----------------------------------- -------------------•--------•-----------------..----------- <br /> -=---• -•---- .............. ----------••----•--•--•-----••-----••------------ <br /> ----------------------- •--•------- "' --•----_-- <br /> "p- ••----------------•-----------------------------------...: <br /> �•r --• _1----`-�•• `-----•1 <br /> ------------------------•------------------- --- ------ ----- --------------------------------------------------------... _----•-----•------•-•----------------------------- <br /> -------------------- ------------------------ �------ -- - ----- - - ----- - ----- ---------•---------------------•------•--------•--------------•', ---------------------------------..... <br /> FINAL INSPECTI �_ -_ - ---. - <br /> Date - -------- ----------------- <br /> FINAL <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stroh 1,1104300 West Oak street 124 Sycamore Street 1 205 West 91h Street <br /> i <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />