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APPLICATION POR SANITATION PERMIT <br /> ---- --- --- ---- -- <br /> — P y Penn <br /> ---------------- <br /> ------------- ------ it No. .. `� !��( <br /> ---- I_ - __ (Complete in Duplicate) �` S •-� <br /> This Permit Ex fres i Year From Date Issued <br /> Applicationis herebyDate Issued <br /> mode to the Sen Joaquin Local Health District for a permit to construct and install the work <br /> This application - made in com liance with County Ordinance No. 549. <br /> •' herein described. <br /> JOB ADDRESS AND L`OCATiO -�- r! �° e4 37 <br /> 1 <br /> a-/1 "ter-. <br /> Owner's Name___._ --- <br /> P_- E . r { <br /> Address__.._.�_ -- -- - ---------------- <br /> --------------- ------ -------•----- <br /> 7/Z---------fit ?_-T ?�QLf} ' : '4+ <br /> +. hon _ <br /> Contractor' Name._____-©- <br /> �� .. <br /> ---------------•----•--- ---------••-------"--------------------------------------------------------............. <br /> Installation ill serve; Residence <br /> •------ <br /> --•- Phon <br /> )Apartment House ❑ Commercial r I w -----•---......••---- <br /> Number of living units: __�"-.- Number of bedrooms ❑ Trailer Court ❑ Motels❑� Other ❑ <br /> ' o Number of baths <br /> Water Supply: Publics stem Lot size _ ice <br /> Y ❑ Co system 'Pr'i atm_ - ........................... <br /> Character of soil to a depth of 3 feetSand ❑ Dep+h TO Water Table _� {# <br /> 1 y � �Gravel [] So dy Loam Clay Loam Y 0 <br /> Previous Application`Made If es date__._.."--- <br /> ❑ Cla r Adobe Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:_l�No _ New ^ - �— - s <br /> Cons#ruction: yeS tom" iVo <br /> ❑ FFiANA: Yes No <br /> (No Ofic tank or cesspool permitted if public sewer is availableIr <br /> within 200 feet. <br /> Septic ) r { <br /> est wellfJN Distance from <br /> o _ <br /> p Distance from near p <br /> Disposal;Field: Distance from nearest well- --_ - r Liquid depth Material'i t <br /> [ Dfir " jQrj <br /> No. of tom artmen s_-_-_---fir <br /> tDi'stance from founds+ion..__ capacity <br /> ----• Qd N <br /> t '✓ Number of lines------1--j- ._ -F 4p--• -- "s <br /> Distanceto„nearest )of line.____ <br /> - --- ----------Len' th•of each line.__.__._ __ _ <br /> __'--- - -- __.- -._..y- F <br /> Type of filter material.--- f �g �+� Width of trench#--"-_• jt ' <br /> ! "---.__Depthf fw. iltermaterial___-- �r { <br /> Seepage*Pit: Distance to nearest weft ____________ Dry}ante from foun Iation-------­----_----,Disal length-__-- -- r <br /> E Number of pits------------- Lining ma�riaj."------•--- Lance to nearest lot line_..-----•-•-__ . r <br /> ` Size: Diaitiu# r�!�++-- -------------De fh <br /> Cesspool: Distance from nearest well __--Distance from foundafiion _"-_- ------------------- <br /> - <br /> �."" . <br /> ❑ Size: Diameter--------I----- �---- •1--ming material------------------- _ <br /> ------------- Depth ---------- 3a !' <br /> % <br /> Privy: Distance from nearest well----------------------- ` Liquid C pacify---_-•------ <br /> .. <br /> El <br /> Distance to nearest lof line-------_-- <br /> -- In <br /> Distance from nearest building._---- ----- <br /> -- -- ----------------- __ __ <br /> Remodeling and/or repairing (describe c_ I - -"""-""" <br /> T =: -------------•--•----------------------- t ---- <br /> ---"----------------•-------•-- --------------"----------•-----•-----••--------•-------------"---•-------•--•---"-"----- •-•----•---------------- <br /> -- # i , <br /> --------------------------------•---•------------- --"----------------•----------•---------- --•----(•--------------•------------------ <br /> Ihereby certify that I have prepared this application and that the work will be done in accordance with,San Joaquin <br /> ordinances, State ws, and mles and regulations of the San Joaquin Local Health District. <br /> qum County <br /> ---------------- <br /> _ _ <br /> ----------------------- ---~�-- - _ <br /> By:--I---•-- -,.- an r Cot - <br /> (Owner cl/o o frac' p j" <br /> (Plot plan, Showing size of lot, l f ystem in relation to wells, buildings, etc., canbeplaced on re ---- de). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Bl _ �Q, <br /> REVIEWED IBY_-----•----------------- <br /> DATE------ <br /> BUILDING PERMIT ISSUED - <br /> - ----- ----- -----------"-"--- ------------------------------------ DATE__.-----------------_--•- - - <br /> AhFerafions and/or recommendations ----- - QATE <br /> -------- <br /> - <br /> -- . ., --------------------------------------- <br /> -�.. .---------------------------------------- <br /> ._ <br /> ------ <br /> 'r ^f� ' --------- _. <br /> v . <br /> - ------------------------- ------------------•---------------------------------------------------•--------- <br /> --- ------- <br /> ---- ---------------- ------------- -- <br /> FINAL INSPECTI / I <br /> Date .`_ <br /> 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Stockton,California 300 West Oak Street 124 Sycamore Street <br /> Lodi,California 205 Weil 9th Street <br /> ES 9 REVISED 8-59 2M 5-52 ATLAS Manteca,caiifornia <br /> Bracy,California <br />