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FOR OFFICE USE: PART •3 dF 3 SYSTEMS M <br /> APPLICATION FOR SANITATION PERMIT/! Permit No. .... ... ... <br />----------------------- ----------- ------------ _ . <br /> ----------------------------- ----------------------- (Complete in Duplicate) 4- y /•Z !! G 7i <br /> - This Permit Expires l Year From Date Issued Date Issued .:.................... <br /> 2`fS <br /> 2-1:00••-to <br /> Application is hereby made to fhe 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. cJ9 LpN <br /> 2 2-Y 2 2�_ F. <br /> JOB ADDRESS AND LOCATION----- 1 _ �_. \ .'-- -•--SI_D ....... -------I G_NC <br /> Owner's Name---------- Q -)"--- R_( (C}-#------------------------------ -------------------------------------------- Phone..---------------------------------- <br /> Address-----------3. 0--------EE------;r.0_5Q--------•-------•--Mai>�5T�----------- -------------------- ---------•-........................................9-7 Name__/WC-_�a(V6�)�......:SE TI_� -----TA!-KS------------- F}i3DVl~�........... Phone.47-'...3.9........... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ +Other SWIM <br /> Number of4ii�units: __l-__. Number of bedrooms. Number of baths.___-_-Lot size`___- _�I �9:; __ -- -��.. <br /> _ f ; <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table357ft. f <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe❑' Hardpan ❑ q' <br /> Previous Application Made: (if yes,date--------------------) No New Construction: Yes ❑ FHA/VA): Yes 0 r No ®— f� <br /> -TYPE OF INSTALLATION AND SPECIFICATIONS: `E " T `� �..-T„,.. 1_4, ., <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well___�___ Distance from foundation----/ ------Material__- ........ fh <br /> � a�� J_ _�%� Cacity_.__ <br /> Disposal <br /> ?®Q <br /> Field: Distance from nearest we€I._A0 ---Distance from foundation.•__� Distance to nearest�lo �� <br /> ---•---- of <br /> Number of lines_________ __ __.________Length of each line_.---- ___ //_.7Width of trench________ _f_ _______ <br /> .� 9 <br /> ►•" "Type of filter rriaterial: Q'_Ct' _:____Depth of filter material_____f ___ .Total length______1_,�............................ <br /> Seepage Pit: Distance.:to, nearest well____1d ___�Distance..from foundation--- Distan to nearest lot line....___--_ <br /> " ' rt' <br /> Er Number of its.-.__ - �'#` Linin material'- Q_i1�lSize: Diameter_yx <br /> p' -.__. g Depth. A ----------- <br /> Cesspool: Distance from eaiest well________________�Distagce"":from foundation...=----------------Lining material_--_____._..________________________- <br /> ❑ Size: Diameter-------------------------------------- Dep-h ----------------------------------------------Liquid Capacity7-------------------------gals. <br /> Privy: '--"b`Distance'from"neare"st well-»-" ''�___________________.____-_-_-._.__Distance from nearest building__________---___4______________-_______- <br /> CI Distance to nearest lot line------------------------ r` --------------------------- -•-•-•---- - --•---- - j <br /> Remodeling and/or repairing (describe):-------F4a-----5.W.I.=�►''I.- po.a ---T°1�-F------�`.__�J -——I- - -•---------------- <br /> { ..------------- <br /> ---••-----•--•---------------------------••----------------------------------------------•---- ----I--------------------------------------•--------------•---• -•-------•----•-•-•=...---- --------------------- <br /> f . ......." <br /> I hereby certify that�I have prepared this application d that the work will be done in accordance with Sam Joaquin=County <br /> ordinances, State laws, andirules and ulations of the,S ti J aquin Local Health District. <br /> {Signed)._ ---- -- --- = {.Owner.and/or.Contractor) <br /> - <br /> By:----- ------ =--- •--------------------------------------------- ---- - {Title) <br /> (Plot plan, showing,sire ofdlot, Iota+io iof system in relatiiooe�to wells,�buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ .--0-'--------------------- -- - - - <br /> --- --- ------------------------------------- DATE-------e7=19 _Z__2 -------------- - <br /> REVIEWEDBY----------------%-' ------------------------ -----------------------------------------.-. --------- DATE-------------------------------------------------_----- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------•--•---------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:---------------------------------------------------------------------­--------------------------------------------------------------------------------------- <br /> -------------------------------...-------•------.-...-----•-------------•----- ---------------------r-------------------------------------••--•------------------------------- <br /> ------ --------------------------- --1----------------•-----•----•-----------------------------._r:: ;_-•--------------------- <br /> :...... ----------------------------- ---• ------ --- ------ - ---------------------­----------- -------e--- -------`--------------------------------------------------------------- <br /> ----- ----- -------------- -- . <br /> FINAL INSPECT • N= A Date:._ "' f---`- � --- �`------ ------------ <br /> SAN JOAQUIN LOCAL HEALTH OfSTRICT <br /> +•'�'�* 130 South American Street 300 West Oak Street 24�ycpmore Street 205 West 9th Street <br /> Stockton,California * Lodi,California - '14onte cr,C_allfornia Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br /> J <br />