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.,�; Permit-No. <br />--------------------------------------------------------- _APPLICATION FOR SANITATION PERMIT <br />------------------------- - ----------------------------- (Complete in Duplicate)._ <br /> Date Issued <br />------------------- --------------- ---------------- --- This Permit Expires'I Year From 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 app icaI' tior! is made in compliance with County Ordinance No. S49. <br /> ,,. . - <br /> iA(�f-e...... ....... ....rc.,. J 00 C------ ......... <br /> J09 ADDRESS AND LOCXTION.--t <br /> Owner's Name-------l3-S?-y....•..1)N_ql----------4-1-V-41 ---------- ----------------------------------------- Phone.4......... <br /> Address---------. .... .A ;Z ------------------------------------------­---------­..................... <br /> - ----------- ------------�49_A_T <br /> Contractor's Name__.e.�... ------- --------------lvjadt�s.Tk?-------------- <br /> Installation will serve: Residence C] Apartment House E] Commercial [I Trailer Court [-] Motel [] Other 0 <br /> 4,4_.6:.V <br /> __.;K......C&A <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --------- ------ <br /> Water Supply: Public system F] Community system El Private E] Depth TO Water Table ---e- ft. <br /> '6 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe F Hardpan 0 1 7' <br /> Previous Application Made: (if yes,date--------------------) No Fj New Construction: Yes No C] FHA/VA: Yes E] No g <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic. Tank: Distance from nearest well-WAIVC..Distance from foundation------j.9........M a f e r i,I <br /> No. of compartments---------------- size--- Liquid depth----------V--------__._Ca pacity....................... <br /> A - from j�ou:ndation--------------------Distance to nearest lot line............. <br /> Disposal Field: Distance from nearest well--mli- Distance <br /> Number of lines------------------ --- <br /> ------------Length of each line--------- ....................Width of trench --------------------- <br /> Type of filter material...?.t-_808 Depth of filter maferial-l-e-----__---Total length______ ---------4-, <br /> Seepage Pit: Distance to nearest well------------:---------Distance from foundation---------------------Distance to nearest lot line________.._..._.. <br /> ❑ <br /> ine----------------- <br /> F1 Number of pits------___ Lining material-----------------------Size: Diameter----.------------------Depth-------.--_-.-.---..------------- <br /> Cesspool: <br /> epth--------- ----------------------- <br /> Cesspool: Distance from nearest well-----------------Distance:from foundation--------------------Lining.material______.____.______________ <br /> Size: Diameter------------ ---------- --- De- - pth--------------------------------------------------- ----------- <br /> Capacity----------------------------gals, <br /> Privy: Distance from nearest well------------------------------------------ -------Disfance,from nearest building__________-__________________...___.__._. <br /> ❑ Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot line--------------------------------------------------------__.............__---------------------------------------------------------------- <br /> Remodelingand/or repairing (describe)=-------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ........................................................................................................I------------------------------------------------------------- ...............I...... ....................... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------- <br /> -------------------------------------------------------•--......----------------------------------------------------------------------------------------•----••--------------•-----------------------•------•----------------- <br /> I <br /> --------------I------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San.jj6iquin.Local Health District. <br /> 191yr�_4!.A11_ -------- _'11,*----------------------------------------------------........-1-----(Owner and/or Contractor) <br /> Ely:------ -------------- -------- - ------------------ <br /> --------------------------­­----------- <br /> buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot. Ica�, ysfem in relatiori to wells, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----------------------- <br /> 13Y___ 14_A� ----- ------------------ --_------------ <br /> REVIEWEDBY--------------------------------------------- -------------------------------------------------------­------*,--*-*--------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------------------------------------- --- - --------- -------------------------- DATE------ <br /> /or <br /> 7 C ------------------------------------------------------- <br /> Alterations an ecommenctations:____ �AAA_t.,_ -------L41--1------44-4?—------------ . ....... ----------- <br /> � <br /> ......to------- i.Aj1_-__b-1....Z_a�_ c. ......2= ------------ ----- ...... ................. <br /> _­�------------------------------------------------------------------------------------------------------------------------ ----------------­---------- <br /> --- ----- <br /> -------------------------------- --------------------------------- ---------------------------------------I-----------1-----------I-------- ------------------------------------- ------ <br /> ----------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------------------- -------- ---------------- <br /> FWAL INSPECTION ------ k&L -------------------------------------- <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 /> ES 9 REVISED 8.59 PM 5-62 ATLAS <br />