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FOR OFFICE USE; <br /> ------------------------------------ Permit No. <br /> I , APPLICATION FOR SANITATION PERMIT <br /> ------ ----------------- <br /> (Complete in Duplicate) Date Issued <br />----------- ------ -------- --------------------- -------- <br /> This Permit Expires 1 Year From Date Issued <br /> ----------------- ---------- <br /> ------------------ <br /> al Health District for a permit to construct and install the work herein descr'ibed.. <br /> Application is hereby made to the San Joaquin Loc <br /> This -application is made in cola I' ce with County Ordinance No. 549. <br /> mn <br /> JOB AbDRESS AN LD ATION_.___ ---- - - H-- - ---- <br /> r <br /> Phone-•---•------ <br /> .------ <br /> Owner'sNap <br /> Al <br /> ---- ----------- --------...........�!......................... <br /> ........... <br /> N e d__---------------------------------- ..- I -- - --- ;�Z ----- <br /> q. -------- Phone_-----------_--------------- <br /> "M ------------------ ---•--•----• -•------- <br /> Name---17 -- ---------------- ❑ D 0'PLZX <br /> t�, Irnlent H.se t. Commercial n- �of ba Trailer--Col� Mote <br /> Installation will serve: I Residence ACRR A 6F- <br /> 7. - h ---1 <br /> Lot size._. -A K9 -----------_- <br /> Number of living units: -1----- Number of bedrooms <br /> -3`0-ft. <br /> Public system [3 Community system Private Depth T ater Table <br /> Water Supply: Hardpan [3 <br /> Clay Loam 0 Clay E] Adobe❑ <br /> Character of soil to a depth of 3 feet:11 Sand A--1 0 Sandy 'Loam. <br /> Ii I No Ar'-'New Construction: Yes]a _Nc,[:] FHA/VA,. Yes E] No <br /> Previous Application Made: (if yes,date------------- <br /> TYPE-CIF INSTALLATION 'AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) r rlei9i 5 <br /> I Distappe from foundation_--.- ate <br /> Sept' .,Tank: Distance from nearj?sf well---/,* 'I - - 7—)(5--Liquid de----_ <br /> --- Capacity... <br /> No. of compartrne4s__,-? ------ <br /> P9 ---------- Si ,ae - -------17-------------- <br /> .0 ,e _Wance to nearest lot line-------------_- <br /> tion---- <br /> Disposal Field: Distance from neares well/ <br /> ---Distance from foundation.... <br /> of trench--- <br /> Number of lines_____F ---- --6---------- ----Length of each line___ <br /> .1� 'R rial -_--Total length----------- <br /> ,__,T.ype_of&lt9� mate ......C_J_�; �---Depth of,filter plate <br /> -e from foundation--------------------Distance to nearest lot line-_--------_---- <br /> Seepage Pit:,' Distance to nearest well-------------i--------Distan( 1% Size: Diameter--------------- --------Depth--------------------------------- <br /> Number of �ifs_-------------------Lining material--------------- <br /> 171 It I _�/ i _Lining material...._--.-..-...--........_._.._..... <br /> Cesspool: Distance from nearest well.)_, __'�--.-.._Distance from foundation.-_----------------Lining <br /> ----- -- - --------- ----='--------Depth-----------------i------- --------------------------Liquid Capacity----------------------------gals. <br /> ❑ <br /> F.-cr,.hea rest building--------------------- -------------------- <br /> Privy- Distance fr�T neai(;4�well- ------------I--------------------- <br /> ---------------------------------- ----------­------------------ <br /> Distance to,neares lot link_ -------- <br /> ------------------------------------------------ <br /> - ------------------------------------------------- <br /> Remodeling and/or repairing (describell:---------------------------------------------------•--I =I ------I--------------- <br /> I i I------- _i;(in,_� ---------------------------------------- <br /> ------------------------------------------ ...... <br /> f -------------------t... <br /> ----------­------------------- ----------------------------------------------------------- <br /> - ------- --------------------I------------------------------- --------------------------- <br /> -------------f----------------------------- T------ --------------------------- --------------------------------------------------------------------------- <br /> ----------I-----------------------------------------_----------t---------------------------------------------------------- with San Joaquin County <br /> I hereby ece ify that ha�e prepared this application and that the work will be done in accordance w <br /> c , laws, <br /> r tions of the San Joaquin LOU Health District. <br /> ees' S laws, rules lotions ordinances; <br /> ------.(Owner and/or Contractor) <br /> ------------------------ <br /> --------------------- <br /> .. . ......... <br /> e, _�_7 <br /> 6 (Sigp�d)-------7 --------- <br /> i V :-------------------------(T fle)---------- ----------------------------- --- -- ------ -- <br /> ----------------------- -------­------------ -------- -------------------- on reverse side). <br /> be-placed <br /> (Plot plan, showing SiZG Of lot, location"Of system in relation to wells, build in gs,-efc-.-can <br /> FOR DEPARTMENT USE ONLY <br /> 'IV DATE / -` <br /> -------------- <br /> --------- <br /> APPLICATION ACCEPTED BY----—7 TT_3Tc.0_f------------------------------------- --------------------------- <br /> I DATE-------------------------------------------------------------- <br /> REVIEWED BY------- --------------------- DA <br /> ------------ -­--------------------------------I-------------------- �;TE--------------­--- ---------------------I--------------- <br /> 1, BUILDING PERMIT ISSUED------------------ ---------------- <br /> Alterations and/or recommendations----------------------------------------I------- ----------_--------------------------- <br /> I ------------------------------------------------*-----------------------------------------------It--------_------------------------ <br /> -------------------------------------------------------------------------------:-------- ------!------------------------------------- <br /> ----- -------------------------------------------------- ------- ----------------------------------- ------------------------------------------- - ------------------------- <br /> ----------- --------- <br /> ------------------------------- <br /> ------ - ----- ------ ----- -- -- ------ ----- <br /> --------------------:----------- --------- ..........-------------------- _7.................. <br /> - - -------- -- ------ ------- ---- ......2-6 <br /> ----------------------- ................. - - --- ------- ----------- ... . 0 <br /> Date... ------------ ----------------------- <br /> FINAL INSPECTION x�-------- --------- ------------ ---- - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 124 sycamore Street 205 West 9th Street <br /> 130 South American Street 300 West Oak Street <br /> TracCalifornia <br /> Stockton,California Lodi,California Manteca,California y, <br /> ES 9 REVISED B-59 zM 5-62 ATLAS <br />