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FOR OFFICE USE: + <br />- <br /> -------------------------------------------------------- <br /> APPLICATION i SANITATION PERMIT Permit No. ................... <br /> -----------=--------•-------- -------------------------- (Complete in Duplicate) <br /> Date Issued <br />_ ..____.__.___---._- __________________ This Permit Expires 1 Year From Date Issued 2-Y-? _ ,5,0-0 <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 <br /> �N`o..S ? 1 SCA L-O ) <br /> JOB ADDRESS AND LO ATO©N (D __ AfV.T E, - ! r <br /> S . . <br /> - ---��--------/Vat----- ._...._ -.. ._ _ <br /> Owner's Nampe.... -Rp _1K---------- � ��5- -------------------- - ---­------------------- Phone• .... <br /> Address--_--1__`-al..._13P -....... ---------------)-Z--`m-F__ _t;n-N-K --------------------------------------------------------------------------------------------- <br /> Contractor's Name---------0-LA)JVJZf�1...._..-----------•-------••----------• ------------------•------------- •-------•---••--•---.._.-..--------- Phone----------------------------------- <br /> Installation will serve: ResidenceApartment House [-] Commercial E] Trailer Court [IMotel ❑ Other CINumber of living units: ___ ____ Number of bedrooms ----t--- Number of baths -__�__. Lot size _5�_.__k._-__.�39P------------------------ <br /> Water Supply: Public system ❑ Community syst ❑ Private �epth To Water Table �55 ft. <br /> i <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay'❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {If'yes,date___________________} No New Construction: Yes J- o ❑ FHA/VA: Yes ❑ No iy <br /> `TYPE-rOF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c <br /> No. of compartments__-__-- Size' fo ndation____h.._-_._--.M�t�rial---- - pp.�............... U' <br /> Septic ank: Distance #r nearest well-_15-0---I-Distance f om R�iquid Capacity----- <br /> p N <br /> ( <br /> Disposal Field: Distance from nearest well._ __.:_Distance from foundation._____ :_Distance to nearest lot ltne...fF . <br /> Number of lines___..__.._f.__ Length of each line------- li Width of trench..._..----�6---------------- <br /> lJ f <br /> i Type of filter material._ �C�„'-Depth of filter material------r0....___...__Total length___.__--�� rr <br /> Seepage Pit: Distance to nearest well------_------------I_Distance from foundation---.-----------------Distance to nearest lot line--------._______. \ <br /> [] Number of pits-----------•----------Lining material-----------------------Size: Diameter-----------------------Depth-------.------------------------- i <br /> Cesspool: Distance from nearest well--------------I.-Distance from foundation--------------------.Lining material------------------------------------- <br /> _..,__7 <br /> ElSize: Diameter-------------------------------------Depth_----------------------- ;----------------------Liquid Capacity----._....--------------.---gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distarice from nearest building._____---_-______________.__--__--___.._. <br /> ❑ Distance to nearest lot line----------------------------- t-•------------------•-•--------------------•------------- •-------------------- c" <br /> Remodeling and/or repairing (describe);------ -- --------------------------------------------------------- -•-•--•----------------.--•• `------ -----•------------•------------•---- <br /> -- <br /> ---------------------------------------------------------------•---------------.----------------------------------------------------..-.•--------------------•-•.----I------------------------------------------ ----- <br /> I <br /> I hereby certify that I have prepared this application and that therwork will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. <br /> t. <br /> SI nod <br /> ------ _- - _----------- - ------- ;. _ :--- (Owner and/or.Contractor). <br /> (.i9 ) <br /> By:------------------------------------------------------- ------------------------------------------------------------`---------...(Title)--------- ------------------ --------- ----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----- �t_R,C?--------------------------------------------------------------------- DATE--------- -- -/--'--`�a`��--•----•-------------- <br /> REVIEWED BY---------------------------------------- ------------- = ----- _•__ DATE------------------------------------------------------------ <br /> -------------------------------- <br /> PERMIT ISSUED-------- - DATE.. <br /> Alterations and/or recommendations:____// -- -- � T�-----/A-- _ 1 J_L _>------- <br /> 7i -•-----/fb�f!_ <br /> ._tNi4f}7------ Fili �'i-4av N- Y�3iR�,Y_ "�!��-1�- bFt __. .i ?7�� <br /> ---�'-----��- _-�---------------- -- ------ ---------------------------------------- -----------------•------------------------------------- -_--------------- <br /> --------------------------------- <br /> ---•--------------- -------- <br /> ..FINAL lNSPECTI Y:_. " _ �g ------- ••------------ <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street ' 205 Wert 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS - <br /> r <br />