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r ' <br /> +_ 1 <br /> .(,Y- APPLICATION FOR SANITATION PERMIT Permit No. 1�_UfC <br /> (Complete in Duplicate) <br /> Date Issued 0-23 sr <br /> Applicafion is hereby made to the 5-an 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 No. 54 <br />' <br /> r JOB ADDRESS AND L ATIO <br /> -*1 <br /> Owner's Name �-----_--_ _._ . ,�[ p <br /> L.X -------- Phones/ - <br /> -------------------=------ - <br /> - --------------------------- - <br /> Contractor's Name-------------'--___ _- _-t__ <br /> - --------------- ----------- ---- - ------------- - ---------------- ----- ------ Phone----- -------------••-------------- <br /> Installation will serve: Residence ,��� <br /> I partmenf House E Commercial ❑ Trailer Court E] Motel E] Other <br /> ❑ <br /> Number of living units: -------- Number of bedrooms ___��__- Number of baths -_-- Lot size .-- 6__ � <br /> Water Supply: Public system Community system ❑ Frivate ❑ Depth to Water Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gfavel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No E?' New Construction: Yes E❑ No &1­'�FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if Public sewer is available within 200 feet.) ' <br /> Septic Tan Distance from nearest well__ # l. <br /> Distance from foundation_-ion-Y-t- � ------------------------------ <br /> __ A t'�r�►-�,. <br /> q �!�_---------.Materi l-__---- " <br /> No, of compartments --- <br /> p a4 Size ;~ Liquid depti� -�^---------------Capacity-- — <br /> Disposal Field: Distance from nearest w 11 #641" Distance from foundation--- <br /> � I <br /> - 1�----._.Distance to nearest t line-___-_ <br /> Number of lines----------- Length of each line---�d-__-_� e� <br /> Width of french of fitter material- ------- <br /> of of filter material--- ,r�-_ ___Tota! length___SD______ ___ V1 <br /> Seepage Pit: Distance to nearest we�l �_pistance oundation_,. � //D <br /> / -_.Distance to nearest lot line-/--___._____ <br /> Number of pits---------- -----_----Lining material=-�% Size 'Diameter---_ / <br /> --. - l/ <br /> Cesspool: Distance from nearest well--------"----._-Distance from foundation_.-----------------Lining material <br /> material- <br /> --------❑ Size: Diameter----- <br /> (----------------------- -------Depth---------------------------------- ---- ------------Liquid Capacity ------ <br /> Privy: I - --------- <br /> ---------------gals. <br /> Distancerom <br /> nearest well----------------------------------- <br /> -----_-_'____Distance from nearest buildin <br /> * .� 9 <br /> ❑ Distance to nearest lot Ime---------------------- ------------------'--_.;,_-__ <br /> -------------------------------- <br /> ` Remodeling and/or repairing (describe)_______________ ------------------------------------- <br /> -------------------------=--- <br /> ----- <br /> --------------------------- ------ <br /> -------------- ----- <br /> -------------------------------------------- <br /> -------------------------- ----------------------------------------------------- <br /> ------------------`--- <br /> ------------ -•--------- <br /> - ----•--------------------------------------------------------------------------------------------------------------•---------------------- - ------ <br /> I herebycertifythat I have prepared---red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances State la and rules and�regula#ions of the San Joaquin Local Health District. <br /> (Signed)-+ �. E <br /> ---------------------------------------(Owner and/or Contractor) <br /> By:------------------------------------ -•----- ---------------------------------- ---------------- <br /> Title <br /> - - -- - <br /> (Plot plan, showing size of lot, location of system in relation to wells building s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY *-- <br /> APPLICATION ACCEPTED BY_ _______ Z _.. �-- <br /> ----- ------------------------------ --------- -------------- DATE----�------ ------ <br /> ---------------- <br /> IEWED BY ------------------- -- <br /> ---------- - ----------- •- -- � ----- DATE----------------------- ------- <br /> BUILDING PERMIT ISSUED---------------- -------- --- - ------------------------------------------ ------------------------- <br /> ----------------------- DATE--------------------- --------------------- ---------------- <br /> "h - S: --- --------------------- ------- --------- <br /> commendation <br /> --- ions -------- <br /> an or re <br /> -�. �- P a -- ---- 'jT - --------'3--------- RO-►�`1 ?t r <br /> -- 1 <br /> -- T p�T,T_ U-NAA-OWN-- ------A1-o-------v-'--- 'tea------I--)F_ C----------140 Yu V-E_F k <br /> �----- -F--•------DI T ------ . -------- <br /> -----------------------'------- <br /> ------------------- <br /> ----- <br /> - - ------------------------ <br /> FINAL INSPECTION BY:- - Date....-__- - "`-- _-k ` <br /> - ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street ,132 Sycamore Street <br /> 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> Tracy, California <br /> ES-4-2M , Revised 1.57 EP.CO. t <br />