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FOR OFFICE USE- <br />------- ------------- ------------I------------ PPLICATION FOR SANITATION PERMIT Permit No. Z?Z1 <br />------ ------------­_:------------- ---------- <br />-----------------------,---------------------------------- (Complete in Duplicate) Date Issued <br />---------------------------------------------------- This Permit Expires 1 Year From Date Issued 7—1,50— <br /> fob <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ThisIca ion is made in compliance with County Ordinance No. 549. <br /> ;p <br /> JOB ADDRESS AN lt LOCATION._.._(&(_-:�- <br /> --------- -------------- <br /> Owner's <br /> ...)---------- . ........... .. .... ... .. ..... .............. .... <br /> Owner's Name. ----------------------------------------------------------------------•------ one._9_3&Q—..:L&XX I <br /> Address---..; am -- ----------- ............................................. <br /> Contractor's Name---- . .. .. ..... .... ... --- - ----- Phone.2421-:4.71646... <br /> Installation will serve: Residence) Apartment House E] ,Commercial Trailer Court [-] Motel [] Other [I <br /> Number of living rNum6er of bedrooms -5--- Number of bath, _/---- Lot size .......----------- <br /> Water Supply: Public system E] Community system 0 Private K Depth TO Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel []-'—Sandy Loam El Clay Loam)k Clay ❑ Adobe C] Hardpan C1 <br /> Previous Application Made: (if yes,date-------------------I No New Construction: Yes 0 No FHA/VA: Yes 0 N- <br /> ox,// <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool permitted.if public sewer is available within-200 feet.) <br /> I* <br /> Septic Tank:. Distance from nearest well-----------------Distance from foundation--------------------material--------------------------- ...................... r_o <br /> ElNo. of compartments------------------------ Size-----._.--------------.---------Liqtiid depth--------------------------Capacity.,---------------------- <br /> Disposal Field: Distance from nearest-well-----------------Distance from foundation_-_._-_-- `....Distance to nearest lot line................. W <br /> ❑ Number of ----------- <br /> ------.'Length of each line...............................Width of french..�__-Z-----------*-------------- <br /> Type of filter material------------- --- <br /> - --- --4.Depth of filter material-----------------------Total length_....;._--------------------------------- <br /> Seepage Pit: DistanceI - to nearest 11 100 4. -Distance from foundation t 1of_l1ne'_R&qC# <br /> -- --------- Distance to nearest <br /> Ndmber L kD <br /> -------------- <br /> /----------- <br /> n- foundation--------------------Lining <br /> —Cesspool:- -'-D;sta ce from well-_---______....._Distance Distance rom, material.--- ---------------------- <br /> Size!'Diameter--------- - I U- <br /> -----------------------------Depth----------------------------------------------------Liquid Capacity___'�n.....................gals.�77 <br /> Privy: Distance from' nearest well------------------------------------------------Distance from nearest building-----------------------­I-­------------ <br /> ❑ Distance to nearest lbt-line---.---------------- - --------------7---------------------------- ----------------------------------------f--------------------- --------- <br /> Remodeling and/or repairing (describe): ----------------------- -------- <br /> ---------------- -------------------- <br /> - --------I----------------------------------------- -------------------------- i y I ......I ------------- <br /> ------------------------•----•--••--------------••-------------....---------------------------------- -------------:-------------------------------------------------- ­---------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------*-------------------------------------------------f---------------------------------------- ....... <br /> -------------------I-----------------------------------------------------------------------­­----------------%---------------------------------------------------/---------11-------------------------------­_------------- <br /> I'hereby certify that I have prepared this application and that the work will be done iniccordance with San Joaquin County <br /> ordinances. State laws, and rules and.regulations of the San Joaquin Local Health District. <br /> (Signed)--- i ----- <br /> ---f-"--�!_3--_C�Owner and/or Contractor) <br /> ---------...... . .- ------------- <br /> BY:..... -- - - -------- - ------------------------------------------------------------------------------ -- <br /> (Plot plan, showing size of lot, Iota n of system in relation to wells, buildings, etc., can be placed ontreverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ------------------------------------------------------------ DATE...... 7---6-x-~----------- <br /> REVIEWED <br /> _6­5~ ---------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------_------------ DATE----------------- -------------------------------_------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:--------------------------------------------------------_--------------------------------------------------------------------------------------------------- <br /> _-•-_--•--------------------------------------------------------------------------------------------- -----------------------------------------------------I.......I-----------------••-------........--------------------- <br /> --------------------- <br /> ..................I------------------- <br /> ---------------------*--------------------------------------------------------------------*------------------------------------------------------------­------------------------­----------------------------------------- <br /> . ........-•--------------•-•------------ ------- ------------- -1------------------ - <br /> -- ----- --- -- ------------------------------------------------------------------------ ---------------------------------------- <br /> -------------.........I............................ ---- --- ................ ------ ---- - --- -- ----------------------------------------------------------------------------------------------------------------- <br /> Da I------ ------------------------------- <br /> Date------- ------ -------- <br /> FINAL INSPECTION BY: . .. ... . .......... . ------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Snvet'-- 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />