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FOROFFICE USE: w -• <br /> --,-p------------- APPLICATION 5�3-'- - - -.-"-_ APPLICATION FOR SANITATION PERMIT �' Permit No. .__�_`E �.:X <br /> " �� p 3 rZvF,� (Complete in Duplicate) <br /> This Permit Ex ires 1 Year From Date Issued Date Issued :- <br /> Application is hereby made to the San Joaquin Local Health District for a per t co struc�nd n aII th o k herein described. <br /> Thisapplication ismade in compliance with County Ordinance No. 549. ��f yt e -c, <br /> � M <br /> JOB ADDRESS AND,LOCATION °`,Q, _ 1i� �� A �` '�' ,� /.�'G�: ..--*...... <br /> Owner's Name------- <br /> __. <br /> 77 ----•-----------------------......------------------•----------------.._. Phone.................................... <br /> Address........ <br /> Contractor's Name Q __._.�-tp �!.... <br /> Installation will serve: Residence <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ../-- Number--of-bedrooms 9___ Number of baths _ __ Lot size (! /' <br /> Water Supply: Public system ❑ Commun ty system Lk0*7-rivate ❑ Depth To Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑, Clay ❑ Adobe M__111'ardpan ❑ <br /> Previous Application Made: (If yes,date_..------------ -----) Nod � New Cons-traction:Yes .*No-_ FHA A: Yes 94 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: d <br /> (No septic tank or cesspool permitted if public sewer%is vailable within 200 feet.) t <br /> Septic Tank: Distance from nearest w II_ �j <br /> ®/- I !_Dista J,rom o�undation__/Cr___--.___.Matel___ _.-._____ <br /> e ��' <br /> No. of compartments_�---------•-----_!_Siz �--- _ "--���iquid d�pth___..�--------------Capacity,`i���_..4---- <br /> Disposal Field: Distance from nearest well/A7----Distance from foundation: .._ _ <br /> �(,, t�Q___.....__Distancs to nearest !of <br /> Number of lines------ ,.--•- -�"""--- -- Length of.,eacli lme_._._�'a��� Width of trench__.r2_1--••------------•--�-•- <br /> Type of filter maerial - _ - rDepth of flter material___-,��' "-7---Total length---- <br /> Seepage Pit: Distance to nearest well --------Distance <br /> ❑ <br /> f Afo dation_j0..... .. st n <br /> ce to nearest <br /> -•-lot line-- _•--_.• -- <br /> 4,/of pits___.` % _______Lining material__ O Size: Diaeter_rDepth_t ------------- <br /> CessPool: ze nearest well Distance from foundation_ Lining material <br /> Size: ---------------------- <br /> Depth --- uCapacity -------------- als. <br /> k Privy: Distance from nearest well________-_-----__:_.______----------- - ------Distance from nearest building_------_________________.."_" <br /> ----------- <br /> E ' _ <br /> f Distance to nearest lot line'."__ _-" <br /> ------------------ L;t—-----------------�_­_�_",_---------------------------------------- <br /> Remodeling <br /> --•---- --- <br /> Remodeling and/or repairing (descri ,: --------------------------- <br /> ---- -_- --- <br /> ----•----••---------------------� <br /> i -------- --------------------------------- -----------•------------------------------------------ .---------"•--------•--------------- <br /> I hereby certify that I have prepared this application and,4hat the work will be done Jin accordance with San Joaquin County 1 <br /> ordinances, State laws, and rul s and regulations of the San Ja guin Local Health Distfict. . <br /> a= <br /> (Signed) J <br /> ------------ <br /> By;---------------------- •---------•----------- A92K [Title)--, Contractor) <br /> ' .- r C or) <br /> ... = <br /> (Plot plan, showing size of lot, location of system ' elation to wells, building/s, etc., can be placed on reverse side). <br /> r' " <br /> FOR,DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ --- -_ �- ---- DATE =- 3 = '` l <br /> - :------- - <br /> REVIEWED BY ----------------------•--- ---_-------. DATE <br /> BUILDING <br /> Alterations and/orTrecomm�end'ations:_--- <br /> --------------------------------------------------- <br /> __ �-_3_!" Gz.2=-----_-- 1- '--•- Y " " QATE------=------• - - -- <br /> -------------------------- <br /> -----------• ---- - -------- ----------- <br /> ,• ---- ------------------------ <br /> ----- - --- <br /> -----•--------- ---•-•-----------------------%--------•-----------••-------- ------------------------- ....._ <br /> -------- ----- <br /> ! <br /> ------------ ----------•-----------• { <br /> -------------------- <br /> --------------------- ................................ - t <br /> I --•-- ------•------------•----•---------------------------------------------- ---------•------- <br /> FINAL INSPECTION BY:- = /!�_---.�_�-- Date------- = <br /> �� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak street ]24 Sycamore Street 205 Went 4th Street <br /> Stockton,California Lodi,California Manteca,Ccliforr'do. Trac <br /> f y,California <br /> ES 9 REVISEt) 8.59 2M 5-62 ATLAS `�- •+ `+ :•,�, <br />