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rUK <br />-------------------------------------------------____-.i APPLICATION FOR SANITATION PERMIT Permit No. <br />----------I----------------- ----------- --------------- <br /> (Complete in Duplicate) <br />-------- -------------- ............... ------- -------- �x <br /> This Permit Expires I Year From Date Issued <br /> Date Issued . <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This' application is made in compliance with County Ordinance No. 549. <br /> 1 p <br /> , 0_4-tj,:�H'T-",4' - <br /> JOB ADDRESS AND LOCATIO' N' <br /> Owner's Name------/ - - ----------- ------------------------------------------------------------------------ Phone'!�--------- ........ <br /> Address._..--------- <br /> 1 W. - -------------------I---------------------------------------------------------------------------------------------­­........... <br /> Contractor's Name----------- V . _ .... Phone.................................. <br /> 11 ...;4-vj- - -- ----------------------------------------------------------------------------------------- <br /> Installation will serve: Residence Zj""'A' partment House C] Commercial [-] Trailer Court E] Motel [I Other (3 <br /> Number of living units- --- Number of bedrooms S. Number of baths Lot size__;?26---------------------------- <br /> ...................... <br /> Water Supply: Public system Community system E] Private g'j-'16epth to Water Table/nep ft. <br /> Character of soil to a depth of..3 feet: Send [] Gravel E] Sandy Loam [j Clay Loam Wa- r-lay E] Adobe [] Hardpan ❑N <br /> Previctis Application Made: (If yes,clote--------------------) No ❑ New Construction: Yes E] No [3 FHA/VA: Yes [I No Ej <br /> 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> '!,'(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se t- T nk: Distance frcim nearest Distance from foundation----149-------- <br /> No. of compartm6nfs-----1P L----------- ....Sizeju;�X_X---W.�`__Liquid dep,th----$e4..............Caace ty.. <br /> Disposal Field: Distance from neawell--4-0--f-Distance from foundation__/e__e------Distance to nearest lot line.4 <br /> .............. <br /> Number of lines__________------------ Length of each line__4_29__` Width of trench-147- <br /> Type of filte'r material./,/, PA__--Depth of filter material--- ________--Total length,_/O <br /> I -A-V-------- ------------....... <br /> Seepa'g Pit: Distance to hearest ---Distance fr f d ti <br /> ion is ance to nearest lot line__�.,f.......... <br /> Number of �'its_-.,,;2------_------Linin-g mate ri a I_AiQ� -.Size: 4 <br /> Diamete -.W-------------Depth-,Z <br /> line' _.{ <br /> Distance from nearest well.________________Distance from foundation-------------------Lining material.--.___._..___._._.._...______..... kk <br /> ❑. Size: <br /> aterial---------- ------------------- <br /> Size: Diameter------------------- ------------------Depth--------- --------------*----------------------------Liquid Capacity-- <br /> Privy: Distance from nearest wlle -------------------------------------------------Distance from nearest building <br /> i --------------------------*­------ <br /> ❑ Distance to'ni.earest lot line <br /> 4 -----------------------------*............ <br /> ------------------ <br /> -7), <br /> Remodeling and/or repairing (describe):-----------------P Zle <br /> ........... 4--- --- e`--- -------------------------------_------------- <br /> -----­-------------------I----­------­- ----------------------------11------------------------------------- ----------------------------­--------------------------------- <br /> ----------------------------- <br /> --------------------------------------------------------------------------------------------------- -------------------------------------------------------­----------------------------------------- <br /> ------------- <br /> -------------------------------------------•-------•-- ----..............................------------------------------------------------- --------------------------------------------------------------- <br /> Thereby certify that 164 prepared this application and that the work will be dome in accordance with San Joaquin Countyordinances, State laws, and rules' and rpu I tions of the San Joaquin Local Health District. <br /> a ion <br /> (Signed)_ ----- --------------- --------_--------------------tmminwor Contractor' <br /> �i By:.............................. -----(Title) <br /> --------------------- ---_---------- ------------------- --- <br /> -- ------------------------------ OIL <br /> (PIo+ plan, showing size of lot. W� Von of system in relation 4016, buildings, etc., can be placed on reverse side). <br /> Ta <br /> ,FOR DEPARTMENT USE ONLY J <br /> APPLICATION ACCEPTED BY. <br /> ------- --------- DATE----- <br /> -- --------------------- ...... ----------- <br /> REVIEWEDBY----------------------------1 M_-------------------I--------------------------------------------------------__----------- DATE- <br /> - <br /> BUILDING PERMIT ISSUED------- --------------------------------------;-------*.....---------------------_-------------- DATE----- -_-•----- ------- -----•-- <br /> ATE----- --------*---------- <br /> ---------- <br /> Meraiions,and/or recommendations:. <br /> ---- <br /> ----------- ------ ----------------------------------------- -------------------------------- -----------------­.­-------------- <br /> ------- ------ <br /> --------- <br /> .......... ------------------------------------------------------------------------ ---------------------------------------------------------------------------------- ---------------------------------------------------- <br /> IN <br /> .......... ..................------------------------- <br /> ------------------------------------------------------ ------ H <br /> -----------:1------------------------ •--- ------------fl <br /> -­------------------------- ------------------------- -------------------------------------------------------------------------------------------------------------- <br /> d <br /> FINAL INSPECTION BY----------- ---------- ---- ------ -------------------- Date-------- <br /> AN <br /> ate-------- ------------- <br /> fAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 0 West Oak Street 1124 Sycamore Street 205 West 9th Street <br /> Lodi, <br /> 1. <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EG 9 REVISED B-59 21A 5.61 ATLAS <br />