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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION .FOO SANITATION PERMIT Permit No. <br /> ------------- ----- ---------------------------------- (Complete in Duplicate) / J <br /> --------------------------------____..__...- This Permit Expires 1 Year From Date Issued <br /> Date issued ...... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and in aF ll_the w�k h4406wibed. <br /> This application is made in compliance with County Ordinance No. 549. –� OI r�"'"" <br /> JOB ADDRESS AND LOCATION---•.............................�/-- .T�C._li----�- -------------- --- •-•-• <br /> Owner'-s_Name------------------------?'—!p_ /U1...-:.__-_.� :Q _ _:_ -------=-•------ : I. m--n Phone_--------.----,-_=_---=--=-= ='=---•---- <br /> TLIJ-r <br /> Address--.--... per, AX-----'��1��-7-------— �I--------•---�f`� '... �G.1c12_-L <br /> Contractor's Name...........•-•-------------------- y_—-------------•--•---••------------•--••---------------------- Phone. --6 d- <br /> Installation will serve: Residence Eq Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J___ Number of bedrooms _;24'Number of baths ---/246-- size ------ d___eK% ...................... <br /> Water Supply: Public system ❑ Community system ❑ Private,PS Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' Clay ❑ Adobe❑ Hardpan ❑ <br /> � <br /> Previoul s Application Made: (if yes,date---__�-------_._) No,9, New Construction: Yes,M No ElFHA/VA: Yesg No El <br /> t TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sepfi&Tank: Distance from nearest well__:'' ____Distance from foundation_____) ____....Material_____________ <br /> No. of compartments----------------------------- ---_Liquid depth-----. -------------Capacity...... a-•_-- <br /> Disposal Field: Distance from nearest well____���_._'Distance from foundatio��»--_____Distance'to nearest lot `/_.__ .. <br /> Number of lines - _'__ ___Length'of each line-----____ Width of trench............_._.-_-_____.___...__.. <br />�. <br /> Type of filter material._._.. �-p "Depth of filter material_.__.._ 4s_____...--Total length_________________________ �2 }_.__ <br /> See a ` 'p ge Pit: Distance to nearest welE___________________iDistance*from foundation_____...__________..Distance to nearest let iine._.._..'__--___ <br /> ❑ Number of <br /> i pits__ _________________Lining mate <br /> ril.-______._____.__-__.Size: Diameter........................ --F-- <br /> -- <br /> r "'. <br /> Cesspool: Distance from nearest well.................Distance from foundation---.----------------Lining material............................. <br /> -w. -..._.-.- <br /> I ❑ � Size: Diameter-_- --.._Depth -- -•---_-- f _-•-----------____��'Liquid Capacity.-------;=_------- <br /> rivy. �� ' c �� i-Distance from nearest building Prwy: Distance from nearest well g................ <br /> ❑ Distance to nearest lot line'---------------------------------------------------------------------------•-•----------------i---------------------------------------------- <br /> w <br /> --------...ry---------------------------•--- <br /> Rem eling_ .nd/or repairing- descriue):-. .^�# ` - :.......: �___---4 <br /> 0. <br /> ---•--•. 4- • --- _. . - <br /> 0 <br /> �------fit _ �n. r:. Q: :.:� r . •- <br /> I hereby certify that I have prepared this application'- d fliat}he`work will be done in accordant ith San Joaquin County <br /> ordinances, State 1 ws, and ru as and regulations of the San Joaquin Local Health District. <br /> (Si9 i <br /> necE�,---- `-�-- ••••------------- •------�JG-- 11�d -- ---------------------..-.-.------------------------•-•----------_-..._-(Owner and/or Contractor) <br /> BY= =?-------------------•------------------------: ---- -----•-----------------`----.------`------------..............................(Title)------•-------------•-•---------------------------------------- <br /> :+.(P,lot plan, showing size_of lot, location._of.system in relation to walls, buildings, etc., can be_placed�on reverse side), <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------- - ---------------------- ---- -- ---------------•------------------------ DATE------ • /----4W------------------------- <br /> REVIEWEDBY-----------------------------------------------------------------------•- i.---------------------------------------•----•--- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-_---------•------------------------------------------i------–--------------------------------.----- DATE---------------------........ ------------------------------ <br /> Alferations_and/or.reqpmmen4afions:. •r------•­--µ ----- _ � _ �.. <br /> J = <br /> r <br /> -------- • - •-- -- a-?.....+ —- - �_ <br /> • t�1�ir t ,G.aces� ----- c4rsa.f-. - _`. _+*r-� - ----- ---------------•-----•----------------------------------------•-------- <br /> y .. 4 .....---- -•---------------------• - ------• <br /> . ------------------ •---•-••------------ -----------•-•L----r------------------------ -------------------------------------------- <br /> SPEC710N BY.. - -- ... - <br /> Date ----------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,Callfornla Manteca,California Tracy,California <br /> ES 11 REVIBEC 8-89 2M p-61 ATLAS <br />