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FACE USE: j <br /> APPLICATION FOR .SANITATIONIffRMIT Permit No. <br /> ---------------------------------- (Complete in Duplicate) Date Issued <br />---------------------------- ----- -----------------------A This Permit Expires I Year From Date Issued <br /> A lication is hereby made to the San Joaquin Local Health District for a permit to construct an T;taill the work herein described. <br /> construct an 1 11 the <br /> work herein scribe <br /> This is made in compliance with County Ordinance No. 5V49,, <br /> .. ... .. <br /> JOB ADDRESS AND L CATION....ln�Il!147 L <br /> C <br /> ------------------ ------- --- -------------------- .... ----- <br /> - --------- <br /> x- <br /> Owner's Name_________52 x,_N_ -- —-------W_ A-/u-C-A�129 <br /> ---- --------- ------------------------------- <br /> Address- <br /> --------------------- <br /> Address........................ <br /> ........... --------------------- ------------------------------------------------------------ <br /> Contractor's Name <br /> ........... Phone----------------------------------- <br /> .......... <br /> Installation will serve; Residence [J,-"Apartment House E] Commercial [3 Trailer Court [-] Motel ❑ Other C] <br /> Number of living units: .__)-__ Number of beclrooms,.7�--- Number of baths &.�. Lot size <br /> Jt�I. ;.4 _�/. <br /> Water Supply: Public system El Com system �ivate E] Depth To Water Table 4.46t. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam Clay Loam [] Clay C] Adobe_ [THardpan 0 <br /> Previous Application Made: (if yes,date____________________) No VINew Construction: Yes [a-<o [:] FHA/VA.- Yes E&.,-O `o [I <br /> #.� ,^ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I I <br /> (No septic tank or cesspool permitted if public sewer is available wifhin,200 feet.) <br /> 0 <br /> Septic T k: Distance from nearest well-)tx0------Distance from fo6nc1afion__/0............Material___ y <br /> No. of compartments------A----------------Size-----"_,Y_Y_Q........OLiquid depth--.--- <br /> — � -- y------Capacity--- <br /> Disposal <br /> Id: Distance from nearest well:/..: Distance from.foundafion., _0_1_____-Distance to nearest lot line.,-57!..... <br /> Number of lines--- ___________!Length of each of trench..-1-:�-VJ._.___..._-_.__-___ <br /> 04 <br /> Type of filter material-11,/ _?��-_kbpth of filter materiaL./O-_------------Total length--- <br /> _,j --j_____________________ <br /> See <br /> .-j--------------------- <br /> See Distance to nearest wdIl_ Distance fro rrk f9undation-_/0....f__Distance to nearest lot I i ne_, ___i_-___._ <br /> Number <br /> Number of pits-_-_-- e'-.____ Lining ..__.Size: Diameter_3U_!�_------Depth:;T_' <br /> Cesspool: Distance from nearb.5f.well ---:,::---_-.._--Distance from foundation--------------------Lining material___.__.-.___--_________________._.... <br /> Size: Diameter-- ------------------------------'Depth-------------- -------------------------------------Liquid Capacity----------•-----------------gals. <br /> Privy: Distance from n'e"arest well------d----------------------/------------ -----Distance from nearest building----------- --------•--------------------- <br /> 0 Distance to nearest lotiline--------------- <br /> Remodeling and/or repairing (describe):----------N_4��!p------- <:------�; <br /> v�-------------------------------------------- <br /> ---------------------------------------------------------------------- ------------------ ------------------------------------------------------------------------------------------------------------ -------------- <br /> ------------------------------------------- ------------------------------------------­------I------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------I---------------------------------------------------------='----------. ----------------------------------------------------------------------------- - <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, St s, and rules regulalfri ns of the rSan Joaquin Local Health District. <br /> (Signed)------------- <br /> b. . .... .. ...... . -------- ----- ----------------------------------------------- ------(Owner an or Contractor) <br /> By:.--------_-------------------- -W-:-Aw- <br /> IC6--------------------------(Tif le)---- --------- <br /> (Plot plan, showing size of lot, I a I n of system in relation to wells, Widings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ----- -----------r ---------------------------------- ----------- DATE...... <br /> .... ----------- <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------------------ -------------- DATE-------------------------------- <br /> --------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------.......... <br /> Alteragons. and/or recornmenctlatiogs:------------------------------------------------------ <br /> c.-_r __-:ia3__.. = ,� �----.. <br /> -------------------------------------;--- ------4G-(-- - ------------------------------------------------------------------------- <br /> e-7----- <br /> ---------- ---------*---------­----------------- ------------------------ <br /> �v------ ----------- ------ <br /> ----------- - --- ------------------ ---- -- ---------------- <br /> ------------ - -------------------�_­_ -------- -----------1----------------- <br /> e49__ ---- ---------- <br /> ---------------- ----------------------- - <br /> ---------------------------------- ---=--------- ------------------- ---------------------------------------------------------*------------------------------------------------ ------------*------------------------------- <br /> FINAL INSPECTION BY:....__. ----------- <br /> ------------_--- Date----- ---------- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 ZM 5-62 ATLAS <br />