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FOROFFICE USE <br /> -------------------------------- No. ............._......13 to q <br /> .APPLICATION FOR SANITATION PERMIT Permit <br /> ----- <br />----- ------------------ ------------------------------- If 4 (Complete in Duplicate) Date Issued --- <br />----- ------- ------------- ------- --------------- --- - This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San--Joaquin Local Healfh District for a permit to construct and install the work herein descrilb) <br /> This application ii is made in compliance.with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.....70-0------5......442�,,z---------—----- -----------------•-------------......... <br /> e <br /> Owner's Name-j?K-L'...... ------------------------ ------------------------------- Phone---------------------............... <br /> C�----- - -- ----- -­­-­ ...........­---­-------------------------------------- <br /> Addre"Ss....70...7..........5�.... <br /> Contractor's Name----- --- ---------------------------------­------------------------------------ Phone---------- ...................... <br /> Installation will serve: Residence 0 Apartment House ❑ Commercial El Trailer Court [] Motel [] Other C] <br /> Number of living units; Number of bedrooms ---- Number of baths .___/- Lot size ­&5-A-249................................... <br /> Water Supply�P.Public system E] Community system [3 Private [] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Saind-E], Gravel .[] Sandy Loam Ej Clay.Loam,E] Clay.E] Adoba§g Hardpan C) <br /> Previous Application Maio: (If yes,date----------­­-,--­) No New-Construction: Yes No E] FHA/VA: Yes E] Nog, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:"' ' . <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well,-X4P1ose-.Distanc9 from foundation----/.0 4-Material--&W-0-12E­TE�.......... <br /> No. of compartments____.-___-__--------Size--14;XkR-X,&e-----------Liquid depth--Dunce <br /> epth-----6-7-- a <br /> WfDisposal FieldDistance from nearest we11,?t&--ftA­Distance from founclation...10 -*- Distance to nest lot line....... ....... <br /> ANumber of lines-------------/--------------------Length of each line--------4-0--------------Width of trench.___-- -4�............ <br /> I Type of filter material.RzIP-&----------Depth of filter material-­3`­0......Total length__- ----------........I 11� , <br /> Seepa,ge Pit: Distance —--__________Distance- ' To,m7ffou"ndaf ion-------------------!'Distance to nearest lot line--------I........ <br /> 0 Number of pits_----------------------Lining material...-----.--=--:---.Size:Diameter_.'........•-------....Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from fou'ndai-,-oh.-��.I...-,-!,Lining material-.__.__.....___._._____.____.__-_._-_ <br /> s ize: Diameter------------------------------------­Depth -------------------------I-------Liquid Capacity----------------------------gals. <br /> 7, <br /> Privy: Distance from neLrest well______________________________ -----------------Distance from�,nearesf building___________________.________________--__-- <br /> I I II X A ­,",- <br /> Distance neare'st lot line-------------- -----------------------------------------------------------------------------------------------------------­-------­•­ <br /> . <br /> 4 j <br /> Rerriciaefing and or repairing (d-pscribe):-------------------- ---------*­............ ------------­---- -------------1-11-:��...... <br /> ---------- --- ------ <br /> .............2770-LZ ........................... <br /> I I <br /> -----------------------------------------------------•---------------------------------------------------- ------------------------------------------------­---------------------------------._.. ....._......-------- <br /> I <br /> .......11--------- <br /> I hereby certify that'I have �rZpared this -application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Statii laws, and,rules�.a' �d regulationt of the San Joaquin Local Health District. <br /> ,p,, tar, T Th 3 <br /> -------------------------------(Owner and/or Contractor) <br /> . .... ... <br /> ........... <br /> (Sijned)-Xn---1­1--------- ----------------- ------ --------- -------------------------------------- <br /> By:--------------------- ; , f -.W =-------------------------------------..._..---- ............... <br /> -------------------------------------------------------­----------------------------------------------------- <br /> (Plot plan, showing size of.,Io+,.Ioca+1�6of system in relation to wells,buildings, etc,can.ba placed on reverse side)­ <br /> rt FOR DEPARTMENT USE ONLY <br /> ------------------------------------------ ---------------- <br /> APPLICATION ACCEPTED BY_._ .__ <br /> -REVIEWED BY.......................---------------- ------------------------------------------I------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED..............••----- -------------------------------- DATE------------------------------------------1----------------- <br /> Alterations and/or recommencrafions:------------------------------------- --------------------------------------------- -------­-­­----------- ............... -------I----------------- <br /> ----------------------------------------—--------------------------—---------------------- --------------------------------------------------I----------------------------------------------------------- <br /> I ---- --- ------------------------------------------------------------------------------------------- <br /> ---------­ ­--- •------t-- --- ---------------------------------------- ------------------------........... <br /> ----------------------------------------------------------------------------------------------------I------------------------------------------------------------------------- ------------I...........I---------------------- <br /> --------------------------------------------------------------------I---------------------------------....... --------------------------------------------------------------------------------------------I------------ <br /> FINAL INSPECTION BY: ''-- --------------------------------------------- Date----- <br /> --------­--------­--------- ......../--------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k Nk ?A <br /> 130 South American Street 300 West.0ak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California—,j Lodi,California Manteca,California Tracy,California <br /> iii <br /> EB 9 REVISED 0-59 RM 5-61 ATLAS <br /> ------------- <br />