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r1_,JK, UN-1I-tvu . 1 8'*f 3 - - - <br /> - 1,. <br /> ..............., f 'I _1- ------- <br /> - ------------- 7) <br /> -ATION FOR SANITATION PERMI, Permit No. <br /> 13 ......... /,!3*P, <br /> ------------------------- ----------- ----------- (Complete in Duplicate]-------- ---------- From Date Issued Date Issued------- ---------- Thh% Permit Expires I Year ad <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance �)�,5�7/K <br /> JOB ADDRESS AND LOCATION : <br /> ---------_------------------ <br /> ..................... <br /> Owner's Name--- _e . ....... ---------------- <br /> X <br /> Z <br /> ---------------- ------------ ------------- Phone-. -ra <br /> Addresi...... <br /> - --------- ---------- ....................... <br /> Contractor's Name- <br /> -erllc------ --------------- ---- -- ------- ----- >~:.,,. <br /> ----------- Phone. R_Xx:•..7 <br /> Installation will serve: Residence arfm' []ent House ❑ Commercial El railer Court Ej IV ther <br /> ❑ <br /> Number of living units: 11L. Number of bedrooms w3__ Number of baths —9— �—--)KI, <br /> Lot size ...... E� - <br /> ------------------------ <br /> Water Supply. Public system &--c—ommunity System 0 Private El Depth TO Water Table 4<xrff. <br /> Character of soil to a depth of 3 feet: Sand 0- Gravel D Sandy Loam <br /> ❑ Clay Loam E) Clay [I Adobe[6---�ardpan C] <br /> Previous Application Made: (if yes,date_____.___.___-_.._) No gj--�N­a, Construction: Yes Ej`lq_o_JE] FHA/VA: Yes El No E3— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> taqk,4Ri:_;eSsPPol.Ptrmi!fe�if P b1i <br /> !!.�l sewer available within 200 feet.) <br /> Se <br /> 4�i jan k: Distance from nearest well-----------------Distance from foundation_________________- - ---Material-------------- <br /> No. of compartments----------- --------------Size------------------------------Liquid dep�k------------- ---- ......I....................... <br /> -------------Capacity------------------- <br /> Disposal,oField: <br /> Distance from nearest well_________________Distance from foundation---------------.....Distance to nearest lot line...___....___._.. <br /> Number of lines.!---------------------------------Length of each line------------------------------width of trench <br /> Type of filter ma Ti material--- ----------- Depth of filter material material-----------------------Total length--,--------------------------------------- <br /> Seepage Pit: Distance to nearest .�1 <br /> Number of pits__ _ -----Distance from oundation_/,,11.1.......Dj'§tanp to nearest lot line 5_' <br /> ------------Lining material ,­_ . —/,c7f 7 __r------------ <br /> - -------Size. Diameter------ 3_1-----------Depth---- <br /> Cesspool: _01\5----------------- <br /> Distance from nearest well__-----------Distance from"foundation--------------------Lining material---------------- ....... <br /> 0 Size: Diameter------------1 --------------------------Depth-------------- -;----*........ <br /> Privy: Distance from nearest well______ ----------1---------------------------Liquid Capacity--------------------I---------..gals. <br /> -------------------------------------------Distance • <br /> from nearest building-------------------------------------- -- <br /> n Distance to nearest ]of line - <br /> Remo lit tor re - - (d <br /> ,-�Fg and <br /> 44 <br /> -------FrrAo� <br /> ---------------------------------- ­--------­-------------------- <br /> X------------------------------------------------------- ------------------- <br /> ------------------------------------------------------------ -------------------- ---------------- -------------------------------------------------------------I---------1-1.............------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> - <br /> ---------------------------------- -----------------------------------------------------------------------------­-------------------------- <br /> ordinances,-Sfafe lows, and rules 'nd.reguI tions f the n Joaquin Local Health District. <br /> (Signed)zf <br /> ------------------------------ (0, r and or Contractor) <br /> (Plot plan­_S_� - ----------------------------------------------------------- <br /> n a of lot ion 0 ysfem in relation to <br /> wells, buildings, etc., can be placed on --------------- ---------- <br /> on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> s <br /> APPLICATION ACCEPTED BY-----------'----------------- <br /> B ---------- ----------I---------------------- DATE------ -- - ----I- ----------- -----REVIEWED BY ------------------------- <br /> - ----- DATE---•---------------- •-- <br /> UILDlNG PERMIT ISSUED _ ---------------------------------------------------------------------------------- DATE ------------------------------- <br /> - <br /> .............................. <br /> Alterations and/or recommendations----. <br /> t --- <br /> ------ ---- 0-------------------- ----------­---------------- <br /> -------- --- ----7 -------- --- - -- - <br /> -------------------------------------- ------_-------- -------------------_--------- <br /> ----------------- ------------------------.................... ------------ ------------ --------------- -----------­--------------------- ----------------------- 1------------------------ -------------------------------- <br /> -------------......................... ..... ---------------------- ------ ------------------------------------------------------------------------------------- ----------------------------------------------- <br /> Date, <br /> FINAL INSPECTION <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sirsof 124 Sycamore Street 205 West 9th Street <br /> Stockton,California, Lodi,CoiffornicManteca,California Tracy,California <br /> ES 9 REVISED B.59 ;!M 5-62 ATLAS <br /> -4 <br />