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i <br /> FOR OFFICE USE: <br /> ......................... .................... . .... Permit No 21 7 <br /> _ APPLICATION AOR SANITATION PERMIT - <br /> (. <br /> ................................. ...... ... . .... .. (Complete in DupGufe) Date Issued <br /> 7 .,-_•.-,-„__.,.-•„•......... .................. — This Permit Expires 1 Yrrar From Date Issued <br /> #: <br /> Application is hereby mane to the San Joaquin Local HealTh 'District for a permit to construct aid install the work heroin desenbed. <br /> r C <br /> This application is mode is r-ompliance with County Ordinance No. S49. Or <br /> L—G�— <br /> k. <br /> JOB ADDRESS AND LOChTIOh!_. z�Uvnl�.....f5.) .. ..1� ...t--rr7c1,,.._.eA..... ..._,.?1�11m._ - - .-lZht <br /> Owner's Mem^........5.............. ..1�.�i. :...1 .,2.U ....._....... _._........... ............_...... ....... Phone__ <br /> ..... .... ....................... <br /> .......... <br /> _..__.. - <br /> - i i 7 i _......... PhoneCar tractor's Name.... .��y.:•..1. .0.)....J:� ....X!CL......�t.. ..V.IG :.._........................... <br /> Installation will serve: Resid9nce e Apartmert House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Q <br /> '•'tet Number of living units: ..'.... Number bedrooms-,j... Nurrbe of baths ... Lot size .... R �•� -- ' <br /> Water Su Public systom ❑ Comm.�ity system ❑ Prueta Depth ro Water Teble' +E�ft. <br /> Supply: 1111111110' <br /> Character of soil to a dcpth of 3 feet: S avel C3 Sandy Loam F1 Clay Loam eClay[I Adobe <br /> ❑ <br /> Hardpan L7 <br /> �,. <br /> Previous Application Mede: (if yes date... ..... . ... ) No Q�New Ccnstruction: Yes 0—No ❑ FHA/VA:Yes[I NO • <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitfel, if public sewer is available within 200 feet.) <br /> sr <br /> -*•�s� Se tic nk: Distance from neores+ well..a.�..__Distence from foun:?a+ion.....l�'.......Matenel...Clrn.C.�iE��..— <br /> P <br /> 'X. quid depth....... <br /> No. of compartmetsSize. <br /> lfl.. to nearest lot <br /> DisposeI field: Distance fnm nearest we!i. _.Sr'J...Distance from foundation... . .. .__...Distance <br /> / ........ �f� -_•.Width <br /> .. __. _._. <br /> Number of lines............ .... Len th of each .... o1 trenchr <br /> » <br /> x rr G 1 ' <br /> _v Type of filter materal....)R15 . Y\...Dcp,h of filter matenol.....�.�s..__._..Tote� le:gth_._ -- <br /> .•.. 1,-G_Distance to nearest lot line._... __ <br /> .� <br /> Seepage Pit: D•stanee to nee- :st wall...../�/C.. Distance from foundation._.. �r l <br /> Number of pits..�1» ...L;ning material._-FC..C.tr�_-.Size: Diameter.... ...........Depth._.._�� ... S <br /> Cesspool: Distance from•n Brest well.......... ......Distonce from foundation..................:.linm� r(sateri°1........... ale. <br /> .;:.I El Size: Diameter............._.. .. ....... .......Depth...................._......_.................__...Liquid Capacity. gals. <br /> Privy: Distance from neores+ well.. _........ .... ..........................Distance from nearest bui!ding..._..__.. ---••-• <br /> ? +: ❑ Distance to neores+ lot line. _........__... ...........................». <br /> ...__»._ <br /> Rcmodoling end/or.repairirg (descrihe):... .... ................................................................................__..... <br /> w-•% _.N .jJF_ ............................... <br /> T..-.L r�.....••-- L '!al._.5.4.>. � <br /> ................ j/.f'F�...... <br /> _.�._._�.....__._.lr .:� �__..:..�5... • <br /> �e I hereby ro that I have_prepared this application and that the work will be done in accordance with San Joaquin County <br /> orermances. t 72'e4't <br /> and rules/end r gulations of the San Joaquin Lout Health Distr'cf. <br /> �/ / <br /> �l'C.11�..L���s ._.......................................................(Owner and/or Contractor) <br /> (Signed)-- ` <br /> ................................._... Itl .....................................................------•-_ <br /> • By:___—•-._.__..---._.--__.._ ._............ ....... °) <br /> } (Plot plan,showing irze of lot, I tion of system in relafion to wells, buildings, etc., can be placed on reverse side). _ <br /> FOR DEPARTMENT USE 0I4LY <br /> rY.. . DATE_.._��_ <br /> APPLICATION ACCEPTED BY........j...R U.. <br /> <................... ....._------......._......_._.._....._.._. _...____....... <br /> GATE__..............____.__. <br /> REVIEWED BY.._..___._.._...-_-•----•--• r <br /> BUILDING PERMIT ISSUED..._......_................................................. <br /> »— -- <br /> Alteratiorss and/or rocommendetions:..................................... ............. <br /> .......... <br /> ......................_.._...._._.—. .._- ......_ _ _....». <br /> — __ ............. • --......_•________-...__._...._______.._.___... <br /> r __._.._...._ . <br /> .___....._.............-............. .................. -----• <br /> .................. ... <br /> FINAL !NSPECTIN-L flY./ ��i l/.1 �!. .....':_.l -/' j t-� Date......... ............_--_...-- <br /> I SAN JOAQUIN LOCAL KEALTH DISTRICT <br /> �A <br /> 110 SooA�American street <br /> Wes,Oot• eH 124 Sycamore Slreel 203 West 9M SrnN <br /> ...�.rS+ecic►en,Collhmb loll,Calfro,nW W0.4to,Cs'Ifemlo Tracy,CelMwnta :. <br /> E!9 REvISEO B-55 2M 5.62 ATLAS <br />