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APOLICATION FOR SANITATION PEN. 4T Permit No. <br /> -41..... (Complete in Duplicate) Date Issued ------3 <br /> -------- ---------- -------------------- --------- ... This Permit Expires I Year From Date Issued <br /> LApplication 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 -r-/ I---C-;1- 6:t /1,)14 <br /> �PCATION.. ........­­............................................................... ................... <br /> L Owner's Name------- , 7 <br /> Address--------7--/--- -------_--------- <br /> 7----------------- <br /> LContractor's ----- __-----------------------_--------------__-------_---_-_---.-.. Phone--------'----------_------------ <br /> Installation <br /> hone-------------------_------------ <br /> Installation will serve: Residence part ant H sa [] Commercial 0 Trailer Court 0 Motel 0 Other Q /; cl,<Ilp <br /> Number of living units: Number of bedrooms Number of baths �Z. Lot size - g--4:--44q <br /> #--- ------------------ --------v <br /> see Water Supply: Public system P,-Community system EI private El Depth to Wafer Talble;�_�- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe 159'Hardpan 0 <br /> Previous Application Made: (if yes,date--------- -- ----- -I No � New Construction: Yes L?`Flo El FHA/VA: Yes E] No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> LSept' T nk: Distance from nearest well.. f stance from foundption-----/0-------Matitrrial�__/rL�-4:! <br /> No. of compartments-------------Lr--------- <br /> Liquid depth.............7----_._--Capacity_.-- cF. <br /> t Disposal..Field: Distance from nearest weIk7._t<1_f"f&nce from foundation.....f/_d Distance to nearest lot ine......r....... <br /> ....I.....pp.- ...Length of each line_________ of french................. <br /> ---- <br /> Number of lines.......... 7 --------- <br /> Type of filter material---;U-tl---�epfh of filter material......1X_------Total length.......7-Am-n.l. LP;2-D.. <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------....Distance to nearest lot line..........._...- <br /> ` <br /> ine............hee El Number of pits---------- .....Lining material....._................Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation------------_------Lining material........._...._-_...________._....---- lf1 <br /> ❑ <br /> aterial-------------------------------------- <br /> El Size: Diameter---------------- ...............Depth----_------------------------------------------.-Liquid Capacity---------------------------gals. <br /> 111. Privy: Distance from nearest well__.............................__.___...._.....Distance from nearest building._..._......________...._.._.__...._ s <br /> ❑ <br /> uilding.............__------_--------------- <br /> El Distance to nearest lot line--------------------------------- -- - -------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):.----------------------------------------------_-----------------------..............................-------------.............................. <br /> ............I——-------------------­...... ­-----------------...........................................--------­---------------------------------­-------..........­-------------------------------- <br /> ------------__---..........-----------------­­­­..........................---------------------------.................------I-------­-------------------------------------------------------------------------------------..................------------------------------_..........................................---------------------------------------------------------- -------------- <br /> see I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C) <br /> Stat <br /> ordinances, Stat and rules and regulations of the San Joaquin Local Health District. <br /> 9s ' a <br /> (Signed ----- ejm�------ ----- ------------------------------------------------------------------------------------..(Owner and/or Contractor) <br /> By:---------------------------------------- ------ -----------------*----------------------------------.-Aritle)-------- ------------------------------- <br /> ------*------------------------- <br /> (Plot plan, showing size of lo+, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-' ' ..Acl�--------- -------- �_------------------------------------- DATE-------' . . — '--------------- <br /> REVIEWEDBY-----_------------- ...............------------- ---------------------- ------------------------------------ DATE------- -------------------------------------- <br /> BUILDING PERMIT ISSUED-----------------------......... .......... ..........r.---- DATE-------'------------Ic ------- <br /> Alterations and/or recommendations:....... <br /> ...... ... ......... <br /> ----------------e.z..e --------- ...... <br /> msr <br /> .��i -1 <br /> ............ -------- ----- <br /> Z-- - '4 �1, - - .r <br /> j( �_e......41.C_0.01.L. c -------•------;1.................-------.................................... .........10......—------ <br /> _e--------- Z"Y.Z -------­...-----....I—------------------------------------- --------.......................................... <br /> .......... �_��- ­------ ----------- ---- <br /> ----------------------------------- -------------- --------------------------------00...... - ---- <br /> .........*-------------------------------------------------0--------------0------------------------------0---­-------- <br /> - -------6:------------------------- - <br /> FINAL INSPECTION BY:------- Date_--------- -- <br /> - <br /> rSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoteliers Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Mont.,et, California Tracy,California <br /> le. ES 9 REVISE. .-59 3. 3-'63 <br />