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rUK urtica ubt: <br /> ----------------------------------- A,.---ICATION FOR SANITATION PERi <br /> Permit No. <br /> ----------}------------------------------------------- (Complete in Duplicate) Date Issued <br /> --------------------------------------------------- This Permit Expires ] 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- ARP"!51=Wcy _------- <br /> A V1 ..... .........I ............. <br /> - --- -- ------------- ----------------------- . ............I <br /> Owner's NamePhone...Iey.�? <br /> . ... .............. <br /> ....� ----- -- -------- <br /> ---- -------------- <br /> es <br /> Address..................................................... <br /> .......... ............. ------------------ ........... ----•----•------------------------------------------------- --- ---------------- <br /> Contractor's <br /> -------------------------------------------------------I-­--­------------ <br /> Contractor's Name-----------------_1 _—-_---------- -------------------------------- Phone.............. ................... <br /> Installation will serve: Residence J4 Apartment House [:] Commercial [3 Trailer Court [3 Motel C] Other E] <br /> Number of living units. Number of bedrooms -3.- Number of baths -./... Lot size ................ <br /> Water Supply: Public system ®Community system [I Private [3 Depth iro Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam [9—Clay Loam [] Clay Cj Adobe C] Hardpan F] <br /> Previous Application Made: (if yes,date___...... No [3-New tonstruction: Yes [;I-No F] FHA/VA-. Yes ❑ No G---- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if PU60csAxer is available within 200 3feej <br /> SeptijIzEnk: Distance from nearest well_....F Distance from foundation--41"..........Material.... <br /> No. of compartments--------.- <br /> I-------- size....... <br /> .3.X07--liquid: clepth....-.*�---------------Capacity...------J-7- <br /> Diwdr6l Fiel' Distance from nearest Distance from foundation......t .....Distance to nearest lot line---------Z-A2 <br /> Rk Number of lines.....-------------- Length of each line---_--------- <br /> ------Width of trench----------------------------------- <br /> Type of filter mate Depth of filter material____- Total length--------__.......j4r.�........... <br /> Seepage Pit: Distance to nearest we{!_____ Distance from foundation........► _Distance to nearest lot line-------Z-�- <br /> ,�OJOPIIF' Number of pits----------- Depth.......... <br /> Cesspool: Distance from nearest well-------...... ...Distance from founclatioh,.h................Lining material_-----__-_--_--.____-____--:-_------_ <br /> ❑ <br /> aterial-------------------------------------- <br /> El Size: Diameter-----------•------k------------- L.Depth------------------------------------------ Liquid Capacity-------- ...................gals. <br /> Privy: Distance from nearest welC"L',t__ ______________________.__._.Distance f4 nearest building____________.______._--------------------- <br /> ----- <br /> Distance to nearest lot line------ ----- ------------------------ ------------•---•----------. ---------------------------------------------------------------- <br /> Remodeling and/of repairing.(describe):--- ........ <br /> 4-145.t...4----------- -_----_----- 4—.4. <br /> ----------- <br /> -- ­--------------- ------ -------- -------- -------- <br /> .�- - ----------- <br /> I ebtcerfift n Joaquin 4a with Sa J <br /> I eby certify that I have prepared this application and that the work will be done in accordance u v <br /> ordinances, StateOws, and rules and re ularflons, of fkoeS'9h:*Joa-quin Local Health District. <br /> (Signed)............. .!�i --- -- -- (Owner and/or ContractorK <br /> ------ - --------- <br /> -- --- ------------------------------------------------ <br /> By:--------- <br /> me) <br /> ------- ---------- --------------- ----------- --------------------------------- --------- ----------------- <br /> t 'L, ----------- ---------- <br /> io 6 <br /> (Plot pia wing of lot, ocatiot-64 syst icLre tido-to,wells:,.buildin(p, etc., can be placed on reverse side). <br /> nc*Wing size C <br /> V DEPARTMENT USE ONLY <br /> Z <br /> - <br /> APPLICATION ACCEPTED BY.--- <br /> ------- -- --------- --- - - -------- ----------------------------------------------- DATE----------------- <br /> REVIEWED BY <br /> ------------------------------- -- - -----------................................... DATE--------------__........ ------------------------- <br /> BUILDINGPERMIT ISSUED---------------- ----------------- -.._...-_i-------------------------- ---------------- DATE.................w___--------------------------------- <br /> Alteratio s d/ r recommendati n ..y--..... <br /> ,;n I............ ........................................................................ ................... ----------------- <br /> -- --------- --- ----­---------------- ------ --------- ----------- ..........I........ .....................­....... <br /> -R-4/ <br /> .............. <br /> ------------- -- - ------ -------------- --- ---------------------- <br /> . .............­------ ­­------------- ------- <br /> .......................��.a------ ------------- - -------------- ----------- - ----------------- <br /> ------------------------------------ ------------------------------------------------------------------------ . . ........=- <br /> --- .................... <br /> I. <br /> FINAL INSPECTION BY:- ------------- Date------------/........... ...c................................... <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />