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FOR OFF CE USE: <br /> ------------------------------- APPLICATION' FOR SANITATION PERMIT Permit No. <br /> ------------------------------------ -------------------- (Complete in Duplicate) <br /> - --- ---- ---------------- This PerMj_Ex ires 1 Year From Date Issued Date Issued ................ <br /> Application is hereby made to the Sari Joaquig Local Health District for a permit to-constr-uct'arnd'install the work herein described. <br /> This application is made,in complian6e"with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIQN...---!F_0---- ------ -----------•------------------------ .................. <br /> Owner's Name-----6 ._:---V!. ....I—Z� ---------------------- ---A---------- ----- <br /> -: ---- Phone._A6. ; Q.kF1 <br /> Address <br /> ---- ---------------------------------------.............................. <br /> ...... ...... . .... ---------............--------A------_-- <br /> Contractor's Name----- -------------------------------------------------------- Phone................•-.-----_ - <br /> Installation <br /> ...............-----------Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [] Motel El Other ❑ <br /> Number of living units: j---- Number of bedrooms .3-. Number of the .4--- Lot size ----t_49.4e.A�P............­ <br /> sy -------------------- <br /> Water Supply: Public stem El Community system El Private Number <br /> to Water Table ..Vqft. <br /> Character of sail to a de7pfh of 3 feet: Sand [-] Gravel E] Sandy Loam [] Clay Loam El-Clay C] Adobe[:] Hardpan 0 <br /> Previous Application Wde: (If yes,date--------------------) No P--"'New Construction. ly es <o FHA/VFHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sewer is available within 200 feet:) <br /> Septic Tank: Distance from nearest well-5.S--------Distance from <br /> No. of compartments.....-__.._ Liquid clepOh______________ _____- ----Caacity....................... <br /> DisposaliFieldt-,,iipistance from nearest welll______Distance <br /> from foundation----LV..........Distance to nearest lot <br /> N6m_be_r'�if:,[i,e,_!---------------V777---7 Leirigth of seach linezy4r D;.1xXW.idth of trench_____ �1 1-Ir----------------- <br /> _.ajy'pe of filter rn�rfe of filter material---- -------Toial length... ------------------------ <br /> Seepage Pit: Disfa'nce to nearest well--- Distance from foundation....G__0_"__..Di!tance to nearest lot line---- <br /> Nun%ber of pifs.l._'�--- ------!Lining maferial!_j_R.0__C_KSize: Diameter------Z�3..........Depth-'---;�45. <br /> 19 It - ____ ____ - I ------------ <br /> Cesspool: Distance from nearest well_t'75.1.'_,Dis_.,Distance from foundation--------- ----------LiAing material._-'------------------------------- <br /> p f <br /> ---------- ----------------------Liquid Capacity............................gals. <br /> Size: Marnefar-------------------- <br /> e -well_------—----- -------- `Distance f ro nri-i-nea rest. building <br /> Privy: Distance from n arest ------ ��Disf .. ..... <br /> ------------------------- - <br /> ❑ <br /> Distance to nearlesftlot line----------------------t.____.____--_--- ---- t 11y <br /> ..............._..­............................I--------- <br /> Remodeling and/or repairing (describe);------A------- -------------A----------------M------------------------------------ ------------------------------- <br /> --------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------=-_'----.".='------•-----•----•---I.._...............-- <br /> .......... -- --------- --------------I t------I <br /> ------- -------------------------------- <br /> - ----------------------- ---------I------4----------------------------------- -- --- ....... <br /> ----------------------------------------------------------------------------------------------­......-------------------------------------------- ......­--------------------------------- <br /> I hereby certify that I have pre'paredthis--applicbtionbrid +hat fhe'woA will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and re u1 tions of the San Jc':taquin Local Health,District. <br /> Si ........ ------------------------------- (Owner and/or Contractor <br /> - --------- <br /> By:....... -------------- ------- <br /> Ze of"system in relation to <br /> ------�..I....... ./­-------------------------------------------(Title)--- A i-----------v.) <br /> (Plot plan, showing si....io ells, guildings, etc., can be placed'on reverse side). <br /> -T FOk DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-7-:07 ------------------------ <br /> ----------------- DATE'�, --- ......... <br /> REVIEWEDBY------------------ .......... DATE'_ ----------+ ........................ ------------- <br /> BUILDING PERMIT ISSUED."'r <br /> ! --------------------------------------------- ........'...-..---u---=---•-- DATE.;;----------------------------------- ----------------- <br /> Alterations and/or recomyjiencr�ktionsl-------- If __ % -4 f <br /> ------------------------ . ........... ................. <br /> ---&---------------- - - -, - — I .... <br /> :IV7 -------------------7--------------------------- <br /> ............ .................... ------------------------- ----------------- <br /> -------------•--- <br /> 's <br /> ---------------- <br /> - - ----------------- <br /> ----------------------7 <br /> ------------------------------------------------------------------------1-1------------------------------------ <br /> o <br /> FINALINSPECTION BY:- ----- - - ----------------------------------------- Date_------------------------------------------------------------------------- <br /> SAN JOAQUIN 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 Tracy,California <br /> JL <br /> ra st jmvpsro 9-59 2M 5-61 ATLAS. <br /> i <br />