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1-UKUNI-Qt U--t/_ <br /> - ---- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------ ------------------------------------ <br />- -----------­-------------­--------------------------- (Complete in Duplicate) <br />---------------------- ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued <br /> for Application is hereby made to the San Joaquin Local Health DiStr ct for a permit to construct and install the work herein described. <br /> 'T <br /> 0 <br /> This application is made in compliance with County Ordinance o. 549,. <br /> e - ----------------- <br /> JOB ADDRESS AND LOCATION--------/V-;?. ---- -- -- - - -- -- ----- ------------------------------------------- ---- ............................ <br /> ----- - ----- PhoA,.-?__x17:: 7 I <br /> Owner's Name------------4�.,__o.....M_e...... . -------- ------------------------- ------------------ Phon <br /> ------------------------ ............. --------- ---------- ------------ <br /> --_----------_ <br /> ---------- ------------------------------ ------- <br /> 2�:_ "( - <br /> -- ---------e-Z-1.......................... Phon <br /> Contractor's --- ---2-r-7.7- -------- _7_------- <br /> Installation will serve: Residence 23---Ap-artment House n Commercial ❑ Trailer Court [I Motel [3 Other <br /> 11 0, <br /> Number of living units: _/___ Number of bedrooms baths ._P-- Lot size <br /> —----------- <br /> Water Supply: Public system 'Commun'ity system 0 Private' F-d Depth toO-ld ft- <br /> Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El _59ndy06;am El-Cjd 'Lo_a_rn�E]—Clay-[] -Adobe.En-*`Hardpa*n 0 <br /> Previous Application Made: (if yes,date--------------------) No [-]i New Construction:� Ye's7E] No,�FH A/V-A- Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is availible within 200 feet.) <br /> P c <br /> SPDistance from nearest well_________________Distance,from fou datio -------- ---------Material-- -- <br /> ------- --------I............................ti . <br /> ill I I I <br /> No. of compartments------------------------Size----------- --.__ •------._._Liquid depth--------------------------Capac.ity....................... <br /> osal C 157 <br /> Distance from nearest weIJA� Distan e from 40'undation../' P. n!---Distance to nearest lot line.......4 �..... <br /> Number of lines_____/---------------------------Length of_each "line_- ---0__-?71 ---Width of trench.__ ff......df J .... <br /> Type of filter -------DeptWof filteiljmaterial----Z-1f,"(1-----Total length-.. -A&--------------------- <br /> Seepage Pit: Distance to nearest weIl_?4_4_k__ ,------Distance frorn'�foundation---,"P.��.----Distance to nearest lot line.......;�5- <,. <br /> Number of pits..../...............Lining mate rial-R-0-MR____..S¢ Diameter-03-11-1 Depth------- <br /> Cesspool: Distance from nearest well.................Distance ounclation--- ---------t------Lining material..__.._._-__._-....................:. <br /> A, <br /> El Size: Diameter--------------------------------------Depth------------- ----- _-0__7--.Y-----Liquid <br /> --- .__0__7--.Y-----Liquid Cap6city...........................�gals" <br /> Privy- Distance from nearest well---------------------------- ----- ----------Distance from nearest building._____.__._.-...__.___.______________ <br /> ;---- <br /> ❑ <br /> -- <br /> Distance to nearest lot line-------------------------------- <br /> - ------------------------ .......................................--------------------------------------- <br /> I! r <br /> Remodeling and/or repairing (des /-------------- ---------------- .............................................. ----------- <br /> ................... ---- --------- ----- <br /> ------------------------------------ --------- <br /> ------------------------- <br /> ----------------------------------------------------------- --------- --------------------------------L-P-...............---------- ------------ <br /> ry <br /> ---------------------------------------------------------- <br /> IAere6y certify that I have prepared this application and th f the work will be done in o ante with San Joaquin County <br /> ordinances, State laws and rules and regulatio S of f Jo uin Lo k-District. <br /> / <br /> 7 ----- ------ ------ - ---- - ---- .-A---------(Qwrrer=WFd74ar Contractor) <br /> (Signed .... -1---------------------- W-,4 <br /> By:........................................................................__.............. --------- le)---------------------------------------------------------------- <br /> (Plot plan, showing size. of lot, location of system in relatio; to ells, 6ildings,' can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----------Jc_ <br /> APPLICATION ACCEPTED BY.C- J 19 - <br /> .0, ----------------------------- DATE-------2—:n_a-ca.n 7.C=_-2--------------------- <br /> REVIEWEDBY------------------------- ------------------------------------,-------------------------- .................. DATE---------------------------------------------------i-------- <br /> BUILDING PERMIT ISSUE ........ ......--------------------­---- -.-- . X -ii---. D;A�E- - -------- - ------&�_. <br /> ------- ----- .......... . .... <br /> Alterations and/or . . . ......... ------�.' <br /> V,_e ----j..Is., .-C..0... ------- <br /> ---------------------------------------------------------------------------------------------------------------- --------------------------------------- .......................................................... <br /> II <br /> ................ ­--------------I........... ...I....................... ...... ------------------------------------------------------------------------------------------------------------------------------------------ <br /> 1� <br /> ..............­....................;---------m-------------------------------------------------------------V----------------------------------------------------------------------------------------------------- <br /> ji <br /> ­-------------- ---------------- -------------------------------- ............................................ -------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY..-_-___-- -------- ---------- Date---------' ------------------- ------- --------- ................ <br /> ------ ------- <br /> IA. JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> 124 Syccmor*Street 205 West 9th Street <br /> Stogkton,California Lodi,California Manteca,California Tracy,California <br /> F0 9 REVISED B-59 VM 5-6t ATLAS <br />