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FOR OFFICE U -11 <br /> /.. � <br /> APPLICATION FOR SANITATION PERMIT Permit No. I <br /> (Complete in Duplicate) Date Issued -.1...:C , <br />----------------------------­­ This Permit Expires 1 Year From Date issued ••`: <br /> Application is hereby made to the San 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. 549. <br /> JOB ADDRESS AND LOCATION----- ---------;--s�Ansz, .1KA-c'-�A-----R-C•....................................................................----------- <br /> 3 <br /> Owner's Name....G..ec)-r--Q,-E--------� ----------•----•---------------------------------------------------------------- Phone............---•.................... <br /> Address--......... . lnr-----------------------------------------------------------------------.--------------------------............................................. ........••............................ r <br /> r <br /> Contractor's Name----------- •---------------------------------------••-•---••-•--------------------------------------------------------- Phone.................................... <br /> Installation will serve: Residence IS Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ Number of bedrooms -�. Number of bath`s .!-- Lot siie ...1-�'Z..____. E3�tti.�3.,`------------------------- <br /> Water Supply: Public-system ❑ Community system ❑ Private ® Depth to Water Table _1_ ft. <br /> aj, - <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay'Loain ❑Clay ❑ Adobes Hardpan ❑ <br /> Previous Application Made: (if yes,date____________________I No (0 New Construction: .Yes_[& No ❑ 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 /> 7- ,' , <br /> Septic Tank: Distance from nearest well_________________Distance from foundation._.-.__.------------Material_____-._..-.-..-_______._._.---------.-•--------- <br /> �-��� No. of compartments--------- -- -------------Size--------------------------------Liquid depth_..._...----- --------- Capacity....................... <br /> Disposal Field: Distance from neares"fDisfance=from foundation...- .`.......Distal cs�tornearest lot line...l. ........ <br /> x� \�9 Number of lines------- ---------------------------Length of each line----- -L'_______-.-....Width of trench----- -------- <br /> Type of filter material.l._7----'cs�r-- _Depth of filter:mater-IaI__T_ =-_-=--=-dotal )Igen fh--- &C' '----------------•---..- <br /> Seepage Pit: Distance to nearest well y:D _i--------Distancejrom foundation--e> -_---___.Distance to nearest lot line...1-S___.._.. r0�� <br /> El. Number of pits-------].............Lining mate rial��`�__-v-ac--k.Size: Diamete ------)_.tom...`......______.___... <br /> Cesspool: Distance from nearest well____-.+---------Distance from,foundation_____________ _____Lining material..................................... <br /> ❑ Size: Diameter----------------------------=----- Depth-::-_•----_'`-------------- ---------------------Liquid Capacity...._ ------------------gals. �„I <br /> Privy: Distance from nearest well-------------------------------------------_-----Distance from nearest building__-._.-..-.._-__________•______-----_____. <br /> ❑ Distance to nearest lot line--------- --••-- -------------------------------•--•---- ----------------•-••--•--------------------------- --••------------------••------- <br /> Remodeling and/or repairing (describe):---- -�-1. 5,x^-.........�-' ---- ,��_.[Lam:_Y�_('4.�._.._.�. .pt _�_t�►. ----------------- <br /> ....l.AA►f--------A''� Z C ASE: = ; <br /> -- <br /> I hereby certify that I have prepared this application and that the work will be.done in accordance with San Joaquin County <br /> ordinances, State laws, and rules a 0regulations of the San Joaquin Local Health District. <br /> (Signed)--- -- ------- ----- •• = r ------------------------ (Owner and/or Contractor) <br /> Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on 4erse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------C '------ ,' ----------------------------••---------------------------- DATE-----�-- :- -3-•----&Z-------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE.--•--•-------...__.----. ---------••----------........... <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--------------------------------------------...-. ----•----- <br /> Alterationsand/or recommendations----------------------- ------------------------------------------------------------------••---•--••-----•-•---------------------------------------------------- <br /> •------------------------- - ---------------------------------------------------------• --------------------------------•--------------------------------•-••--------•---•---•--------. ---- ------------- <br /> F1NA1-BNS-1'ECTION BY:_ _._ � T <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Weil Oak Street 124 Sycamore Street 205 west 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Callfornia <br /> ES 9 REVI~SEP 5.69 ZM 3-61 ATLAS T - <br />