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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -----------•-- --------------------------------------- (Complete in Duplicate) <br /> Dattel' Issued <br />--------•------------------------------------------------ This Permit_E-xpires 1 Year From Date Issued _Z(p 02©jI <br /> rltiD <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. ( MAN-FEC1 <br /> JOB ADDRESS AND LOCA IO'nN+�IDF—:-.---CLF--j9-NDt-_R_.....I----------- � �Q flF ( i��4�. ---. .. <br /> Owner's Name........ •----- --------------------------------------------------•------- -------------------------------- Phoe. <br /> Address...... ..�0 � A�TECi�--------------------------••---•------------------------ l.......................•--------- <br /> ... <br /> Contractor's Name... l�.NTF .......6'.Ea _T.l-C -------•-•-------------------------------- Phone...........------------••--------- q, <br /> Ni f" <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q: Other ❑ p <br /> Number of living units: Number of bedrooms _3__ Number of bathsLot size ..1on__X..�� .......______ .........._------1. <br /> Water Supply: Public system El Community system L] Private Depth ro Water Table .6___ ft. ' <br /> Character of soil to a depth of 3 feet: Sand U�"Gr tel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.__1 ._ )4 No (Q!TNew Construction: Yes ED-'No ❑ FH,.I[ Yes No ❑, <br /> TYPE OF INSTALLATION AND SPECIFICAWTI-0�N—ST` <br /> (No septic tank or cesspool permitted if public tsewer is available within 200 feet.) <br /> SepticTank: Distance from nearest well---L20_.a_Distance from foundation-_ /__C---------Mater al___79-D.............. <br /> No. of compartments--------- Liquid depth------- --------------ICapacity_._.l©Q12---.-- <br /> Dispoosall Field: Distance from nearest well.__5_Q----Distance from foundation___L.O___-____Distance to nearest <br /> ILd' NumberT <br /> T of filter materia { Length of e ch 1ine _�H .-.._L5___.Width of tren�h---r2 _____X_..-------------- <br /> Type <br /> _. ___�_ <br /> ..T._�5. <br /> Yp � .----.---.__Di rete from founds%n1�. _-------Total length-��--------fl.4z.................... <br /> Seepage Pit: Distance to nearest we!! - Depth of filte ,.xn y , Distance to nearest lot line................. <br /> ❑ Number of pits----------------- Lining material.___-__�------ -----Size: [ ibmete---- ----Depth---------........................ <br /> Cess ool: Distance from nearest well. ---------.Distance rom fo ndetian____________ _______Lining material_.________.________.................. <br /> El p Size: Diameter---------------------------- ------Depth--= '------ !-'� I----Li Liquid Ca aci' ------gals. <br /> Priv Distance eat lot line -_ --- --Distance from nearest building____1____________________________._____._. <br /> y: Distance from <br /> ❑ e res -_�------ ---- ---------------- --------------------------- ----- j <br /> elgI -- repairing <br /> p -•r--g (--es ribe):---------------------------------- <br /> Remodelin and/or re airin <br /> -------------------------------- <br /> ---------------------------­- k -----------------•-- -- --------------------.... l -------•-- " .. . <br /> --•---•-•-------------•---------------•--------- jj--- --------I--------------------------- ....---------------------•------- <br /> i i ,� <br /> ------ - --------- --- ------------- •------------------------ # - <br /> hereby ce if that I e pre his ap lication and het the work will'be donein accordance wit�h°,San Joaquin County <br /> ordinances, St a aws, an ales;a. eg let' s f the San Joaquin Local Health District.OF <br /> � 4 <br /> _ -©5--••__ - <br /> (Signed) :, .... (Owner and/or Contractor) I <br /> _.__: - &5_d! <br /> Plot Ian• showing size of lot�lo�a ion_o stem, wel�� . ...-------(rile).....--1 R`5�--.•------------------------------------------ , <br /> ( p g y Is, buildings, etc., can be placed on reve'rse side), ' <br /> : FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY------77_�R-D_---------------------------------------------------------------- DATE------•-7-Ji -7-63-------------------------- <br /> REVIEWED BY--------------------------------------------•------.-------------------------------------------------------------------------- DATE ----------- <br /> ----------------------- <br /> BUILDING PERMIT ISSl1ED :- �. ------------------------------ <br /> - .............................DATE._..-_...... �-------- <br /> Alterations and/or recommendation"s_________________________._ """-- --"' `�-- <br /> II <br /> -------------------------•-•---•-------------•-- -•-------------------------.•------------•----------- <br /> II <br /> ----------•-----------------------------------------------------------------•--- ------------------------------------- <br /> , � <br /> FINAL iNSP N 8 ' <br /> ---- Date.--------- - _ _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 911%Street <br /> Stockton,California Lodi,Callfornia Manteca,Callfomla Tracy,California <br /> ES 9 REVISED a-99 EM 5-6Z ATLAS <br />