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NFT OvFICE USE: <br />------- ------ ------------------------- - - APPLICATION I;QR SANITATION PERMIT Permit No. _1_7402 <br /> -- ------------- -------- ----------------- --------- (Complete in Duplicate)This Permit Expires 1 Year From Date Issued / <br /> 4 __.__. Date Issued ---2/ <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. S49. j <br /> JOB ADDRESS AND LOCATION-----3 -75----------- Gl--FL �--------�- � ------------------------M__'_-7X--A------------------- <br /> Owner's Name ��/ l=O = f 5 K r . ----------- ---------- Phone------------•--•-------------------- <br /> Address------------ -- r — l3-Q-Y-------��`' � �� �����e��! ---------------------------------------------------•-- <br /> tQ t — --- ---------------------------•-------------- �------ Phone <br /> P ❑ <br /> Contractors Name--__ -- __ _ ..-.•-• __-.•. --___-:_ _.°_. <br /> i � <br /> Installa�umber of,livingon will ���_ Number bedrooms -_�Commereial ❑ Trailer �C-attrt Q�Motel ❑ Other ❑ _.. <br /> g i Jam_`_#Number of baths )---- Lot size -J--/�5 __. __�. �--------------------- y <br /> Water Supply: Publicisystem Q'-Community system ❑ Private g>eepth to Water Table ft. <br /> Character of soil to a depth of 3 fee+i Sand Gravel ❑ Sandy Loam [❑ Clay Loam_❑ Clay ❑ Adobe❑ Hardpan [], <br /> I } No P-1,New Construction: Yes Flo F1 FHfA/VA: Yes E] Nog <br /> Previous Application Made: {df,yes,date____ ___ _________ <br /> __ __ <br /> TJYPE=OF-INSTALL-L-ATION-AND._SPECIFiCATIONS: r �_ --� <br /> { (No septic fanVor`cesspool permitted if ublic sewer is available-within 200 feet. 4 �` <br /> SS. --�. p .� <br /> _ ` <br /> Septic Ta ,,:Distance from•.nearest well_____" . Distant firom founds +ion-_- -- _ ____.Mat nal--C&/V.il�A� <br /> �N of m ruts: y----___Size � ��___Liquid depth __ X-�----_�.Capacity.____��__-_0 <br /> —f <br /> Disposal Field: E Distance from.nearest wel( l _ _distance•from foundafi`on__ __- _____Disfiance to, earest lot line---- ____._.a <br /> Air <br /> Nusnbertof€li es___- --------------- .__Length ofkeach line----- --_�_-_/r=---Width of french------ � ,__ _____________F <br /> l<___ <br /> ,Type of-filtedmateria__ _ pf __Depth of filter material___.__: g._>___._Tota] length----------------------- _ ___ <br /> Seepage Pit: Distance to nearest well----____________------Distance from foundation------------- Distance to nearest lot line__.'------------ <br /> Number-of <br /> ________-_ <br /> ❑ Number of pits---------------�---Lining material------------ ----- -----------__Depth--------------------------------- <br /> Size: Diameter___.__ <br /> Cesspool: Distance fr nearest.well_________________Distance from foundation______-----I-____Lining material-_.--___.__.__.___________..________ C <br /> ❑ S' Depth.----------------=---�------------- -------- ----Liquid Capacity---------------------------gals. •� R <br /> Privy: ' D stance f otmr nearest well ___-___________ ____________________._______Distance from.nearest building------------------------------- <br /> ❑ Distance to nearest lpo+ line - ------------------ ------------------------------------------- <br /> g / pairingY111scrl) ---------------- - - - F. _ - - ---- r` <br /> Remodeling and or r <br /> - - <br /> ----------•------------------------ i 4 <br /> ----------------- --------- --:----------------------------- -----------------------------I <br /> -------------------------------- ----------- ----- ----- - ----------------------------------------------------------------------------------- -------------- ----------------------------------- -------- <br /> i <br /> I hereby certify that I have p epared ,+his application and the# the work will be done;in accordance with San Joaquin County <br /> ordinances, State laws. and rules,and regdlafio s of A -San Joaquin Local Health District. <br /> (Signed)------ •------ --- j ° ----- - --- --- - ------------ <br /> --(Owner and/or Contractor) <br /> . - - _ <br /> (Plot plan, showin size of-lot:, I cation+ of sysfem ridrelation to wells, buildings,,etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> r� - <br /> APPLICATION ACCEPTED BY-------'�LI�.�_Q_�---- --------------------------------------------- ---- - - DATE- - - �-�-, �---�----- -----�----------- <br /> REVIEWEDBY---------------------------------Ej--- - ----- -------- -------- --------- •------------------------ DATE----------------------------------------------------------- <br /> BUILDING,PERMIT,.ISSUED___�T.. := . == n _ = 7--------- :. -------------- ___._­—DATE: '=-- t= :_..-_ ^----------- <br /> Alterations and/or recommendations:'_-: 0` iEL4"*7 Z_:ND"0P, -_"` FICf-� :� 'R_ l!�.--_�__________ <br /> --------- 9t>I!_Fr!-1--------- 1__S.H.: fi��{1V _[ a " 1 F_fs'� y ----UN J". _ T�-1_1f b_S-------- --------------- <br /> BL)- <br /> r---- ---- <br /> �1 � 5 �5_.._.._inI' _i .c P � - 1q-Pt�RQu_ 1�. =t...... ._. k <br /> ------TH-f.�aP.. __��y �.....':=f�'i. > �1' `) Q} _ N/ _:_':_ _.. l�Tl <br /> OM `LN r �R ft �"q1� -------�-60-vT- •----`--!-----a�---- -T-1 <br /> � p I <br /> l�t]RKMAn�S H I P` )5 CLQ �r 1. 1 1 R_f <br /> FINAL INSPECTION BY:----. - -- �-- -------.- - Date-------------- . <br /> ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West,91h Street <br /> Stockfon,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F.P,00. <br /> a . 1 <br />