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t�OR 0FF1CIi USE: ti _ -��• _ <br /> ...............................I............--------... APPLICATION FOR SANITATION PERMIT Permit No. ._.,l da...�... <br /> ..................... -I...................--- (Complete in Duplicate) <br /> -- --............-------------•-•.--.--_-....----- This Permit Expires 1 Year From Date Issued <br /> Date Issued --- ••��' <br /> Application is Eiereby 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 /> —7�i� E •�;�t F..�so.J of~ ' <br /> JOB A DRESS�!AND LOCATION._ <br /> ` = a..-��a.X.:3n.. '.. .I'll_ <br /> Owner's Namellt. 0 `�.. - �.I 5 �1 �� �� Phone ............. <br /> Address............ --------------------------------------- <br /> -------------/ <br /> Contractor's me............... 4 R.ts. r...-----............---.....--------•-----•----- Phone....._... J IP'� <br /> Installation will rve: Residencepartment House [I. Commercial ❑ Trai r Court ❑ Motel ❑ Other <br /> Number of living units: .. .._. Number of bedrooms .... .. Number of baths ... Lot size _:3 11. , . <br /> Water Supply: 'Public system ❑ Community system ❑ Private Ej-'Nepth To Water Table�i6ltt lt.? <br /> Character of M l to a depth of 3 feet: Sand [-] Gravel r-1SandyLoam C] Clay Loam �iay E] Adobe[j Hardpan ❑ <br /> Previous ApplicIation Made: (If yes,dcIte5f j.AAAP.K) No ❑ New Construction: Yes 00"'INo ❑ FHA/VA: Yes❑ No Dj?'� <br /> TYPE OF INSTALLATION AND SPECIFiCJINK <br /> (No septic tank or cesspool permitted if public jewer is available within 200 feet.) AA <br /> Sep�tic nk: � . Distance from nearest w L,6-a- Qistbnce'from foundation.!_ .i...._....Material-__Cf1_H C_�' ' _j <br /> 6? eX 15 No. of compartments-...�.- --..- --...Size................................ depth._....�" .... Capacity. ��� �`� <br /> ..... .......Ca acs � .- ----- �, <br /> Dis osa field::; Number of m nearest well: ._ Length of each line.-clatio�_� .Distance to nearest lot line--- <br /> /_070 <br /> ine-__ <br /> p !/ .. ��istenca from foundat <br /> Type of filter mafierial;-4P ./1r�G Depth maters -.... Width of french.....di,y•..- <br /> yP p al IQ.�.___...Totel length-------- --.._.....i.. <br /> i <br /> Seepa Pit: Distance to nearest el1-...fPQ�...__Distance rorn fou ation._. a.._.._...Di �nc to nearest lot line.-.�3 ._..._ A <br /> Number of pits._.� w .._Lining material>P(-7Y_. Size: Diameter eO. ..Depth.....�.-,..?...�_....._._.. 1 <br /> Cesspool: Distance from nearest well.................Distance from fou dation.-.;_.---_-.....ening material......_......................_....... U <br /> b <br /> ❑ Size: Diameter..................... ------Depth......................... ------Liquid Capacity............................gals. 3 <br /> Privy: Distance from nearest well.....?:_-.......................................Distance from nearest building........................................... <br /> ❑ Distance to nearest lot line. ._..._.........................................-=------••.........................-......................... ............ f 6 <br /> Remodeling and/or repairing (describe):......__: .. ..._. Q� ... _�� .GL. ....... <br /> .l <br /> .............._..............................•-...........................................................-•••••-••-•-------••-•.......................•--•-•••-•--•--......_._... ...._........... ...... <br /> -----------------••--- • -•---•....._.........-••---•---....------•-•--•..........._................-•••-----......._...................... .........................................................-.............. <br /> .........................II. __ <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, State laws rules and regula 'ons San Jo uin Local Health District. <br /> i <br /> �z2oro�'-�'�-�(Signed)----_- .-- ............(Owner and/or Contractor) <br /> By: 'Ih.._ ..L�.b¢� �'` .-------------•------------...........(ale)........................-------::.-_------------------------ - I <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate., can be placed on reverse side). <br /> FOR DEPARTMENT USE NLY <br /> APPLICATION ACCEPTED BY.....................................................• (C�- DATE. .. ..... <br /> REVIEWED BY-----••------------•----- . . _ ----------• ------ <br /> DATE._.......... <br /> BUILDING PERMIT ISSUED.............................................................._........................._............. --•-----•-•----....------•----..___ <br /> Alterations and/or recommendations:........................................................................................................................................................... <br /> •I <br /> ..............................•--......_...._._.......................... ................................... <br /> ........................•11 <br /> i--•--._....._.-.. ............................................................................................._......_....._......_..........---------------•-••.............--•---•--....._..._. <br /> FINAL INSPECTION BY: .... ... .. .. --------- Date... <br /> 117;7....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1130 South Al`inwimn Street 300 West oak Sweet 124 Sycamore Sime# 205 Wast 9th Sheaf <br /> StecktengII`Caiifemia led[,Callfornia Manleco,callfomio Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS w <br /> 1f i <br />