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- f <br /> FOR OFFICE USE: <br /> N' <br /> _.._...-__-......._.._...-.._.................... .�=APPLICATION FOR SANITATION PERMIT permit <br /> ----,--._.................................-__......... (Complete in Duplicate) Date Issued ! �- <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�ar in described. <br /> This application is made in compliance with County Ordinance No. 649. <br /> "�N*C� <br /> W L �C 1= I <br /> JOB ADDRESS ANtD'LOCATION/r(.,P..t .-.. ....±Ul. 4 ..... lr�.r... R-E7..... ...... ........its . ..... �..°APoAI <br /> Owner's Name..--..-5!_Fa&j.Q_6+1 ..... Phone..........1....... <br /> f F <br /> Address......,ar... ..4K:! .......-�- - ------u'Z.'N. ...... <br /> t'-t.-----.............._.-•- <br /> r tp <br /> Contractor's Name.... 14/�.7. C "!. r� }?9.! ....... r. .-.... -- •` �``Phon�..... 0��-........ <br /> ...r r W o ii <br /> Installation will serve: ResidenceAparfinent House ❑ Commercial ❑I Trailer Court ❑ Motel ❑ Other <br /> + + r <br /> CT <br /> Number,of living units Z NuFber of bedrooms .."L-Number o bafhs -_r__.- Lot Sze ._. _-------•••- - <br /> Water Supply: Publivaystetn*Q eC mmunl Sys m d] Private Depth TO Water Table is._ ft. <br /> Character of soil to a depth of 3 feet: Sand �iiave�l Sandy Loam cif Clay Loam ❑ jZlay❑ Adobe❑ Hardpan❑ <br /> Previous Application Made: [If yes,date.............._--_) No [�'�New CoLstruction: Yes No [ FHA/VA! Yes C] No <br /> TYPE:OF INSTALLATION AND SPECIFICATIONS:-- --�� - ' <br /> (No septic tank or cesspool permitted if public see is available'w. hin 200 feet.) <br /> Septic 'k: Distance from nearest weil._S------- --Diistance from fot5ndation.../59---------.Ma e ial..---409.hrj.cl iiE_�".. ------ <br /> No. of compartments..-'r— Sized X- .-- ". -Liquid depth.....:. -- Capacity---- <br /> ; -- - �"-'�`- • l—r-�+ � Distance to nearest lot line.---, -....... <br /> Disposal FF old: Distance from mearestiwelf^'�'vy-._Distance from foundation:.._LCI.....__- <br /> � �j r` G'1.. r Width of french.-.._�,3.6.!r....------------ <br /> �Number�f'line' �f./...... ...........Lown gth of each line..___- L <br /> Type of filter moteriakkl..-R-r7-��_.Depth of filter 4terial..y�y'1'S-��1'i. -_._.Total length_...............Q__._............-_ <br /> Seepage Pit: Distance to nearest Jell----- .............Distance from fou'ndati�.._.........Distance to nearest lot line................. 0 <br /> P t _ � r P . . 9. ..- Yrial......................Size: Diameter-..._..._.....------.Depth---------........ W <br /> �Cess❑ool:.. eD> ace from Bare well.................Distance from foundation ... __Lining materiel_-....-.................._.......... <br /> ,umber f its.._-._...-.-__--- Linin mat <br /> ❑ s,+$r aj . .# sp els. <br /> Sae: is fe -._................_ . De th-----..-..-.-.... ------.... ---..-... ....-Ligwd Capacity g <br /> Privy: Distance from nearet well...............------.!_...- -.- <br /> .. Distance from nearest building..........._ <br /> ❑ Distance to nearest lot line..........._.......k_-------------- #---....._�'--.�... ...---------- ....................... .............. <br /> Remodelin and/kor repairing (describe):. -------------------.. --- ............... ....---- - ..........---•---•-.....................-- .......... - ..... <br /> - -----------.............._1........------- - ---- ).._.�_...-........-_........-.................... <br /> ..........._........-_.-. <br /> - ..-._!.......- <br /> ................................ .......................... -------..._ .....---- -� -^ <br /> _�.r..c--!-w�!c---"-..-- ---------------------- ---- .......----- so <br /> V --..-........---......----- <br /> ordinances,is ate laws, and rules a re ula ons of the San Joe uin Local`Heait Diptri m accordance with San Joaquin County <br /> I hereby certify that i have prepared this application nd +ha�fhe w rk wtll 6e d <br /> ,///y, J strmt. <br /> � � - -....�......__T_.. _r__. �. _. <br /> ........ <br /> B '- --------- I n.-----.----o '- A Title)... (owns end.. ....... - <br /> _ r o Contractor <br /> Y,� � - - - -------- y •fit -' <br /> (Plot pbn, showing s'ae of lot, location of system in relation to wdIR, buildi{gs, a#o., can be placed on reverse side). <br /> FOR DEPARTMENT USE[ONLY <br /> APPLICATION ACCEPTED BY_....-T I-............). ..............- ..._�... ---.---------.--- DATE---...-ll.-..�-�.'.Q� .... <br /> REVIEWED BY-----------------------------__--- - ....-.............__........................ .......... <br /> DATE--.-.................................... ........... <br /> BUILDING-PERMIT-ISSUED..-- A7En« -._.:::... - .......-- - -- ...-..-- <br /> Y n <br /> Alterations and/or recommendations:---....................... ... ...... a.�.J_�: .ti F ...... ...................... ........--........... ........... <br /> ........-..................._...-_....._......---------......_....._-........`.-------------_-----------------...................-........__.....I------------..................... <br /> ---------................_...............------..................-_......._...------------------..................................................................................... <br /> ............... -.... .._......-- -" ---- - -- --........------------- <br /> .--- <br /> ---------- <br /> ........-.....---........_........----..------ <br /> ..---------------------------- <br /> ............... .. .-.._. -----......_ ........... ........._......._._.._....._...--._..........--'--•--...............-------------------........_-.......... . <br /> FINAL INSPECTI Date. ....✓ --------3-._ .(1... -------- .......... - ..... <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 So0h A..ricon Street 300 West Oak Street 124 Srcomon Street 205 West 9th Street <br /> Stockton,Collfornio Lodi,California fr Monteco,Colifomk. Tracy,California <br /> ES 9 REViSEO e.59 2M 6.62 ATLAS e.. <br />