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FOR OFFICE USE: 207Z9W*;; <br />- <br /> ------------------------------------------------------ <br />----------- ----------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._._!...:.......�:.. <br />----- --------------------------------- -- -------------P- (Complete in Duplicate) Date Issued <br /> -------------- -------------------------- ---------- This Permit Expires 1 Year From Date Issued <br /> Application 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. C0l-� <br /> JOB ADDRESS AND LOCATION-- R0-OffiS......RD--------1-S ...P149 C___4P ....!v-fl�....�2 <br /> Owner's Name-------------------E—H.8: F1�f U6----------•------------------------ ----------------------------------------------- Phone----------•--•---------_--------- <br /> Address------------- ........MIA TF•509__`------­­------------------- -............................................................ <br /> Contractor's Name.--- ------��—�._J_'_TI G----- ` .��_�_i�•-- -="=-•----------------- <br /> _ Phone................................... <br /> Installation will serve: Residence Iff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�.___ Number of bedrooms___ Number of baths , ... Lot size _---1 ��- - --------•-•----- <br /> Water Supply: Public system E] Comm nity system [IPrivate;El"'bepth To Water TablecApft. <br /> © t <br /> avel Sand Loarr% Cla Loam,Clay ❑ Adobe❑ Hardpan <br /> Character of soil to a depth of 3 feet: Sa� ❑ Y , ❑ Y <br /> `' FHA/VA: Yes ❑ No ®� <br /> Previous Application Made: (If yes date-_.---`-----------) No �Newtonstruction: Yes ®�`lo ❑ <br /> TYPE OF INSTALLATION AND'SP,ECIFICATIONS: a <br /> (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) <br /> ✓ -,z _ «x <br /> Septic nk: Distance :from nearest well_�:��__�Distance from'foundation---- -------Materia{...0 � _ <br /> No. of compartments--- �•---__- --:Size_� /rJ "X5------Liquid depth.....__-------------Capacity_-/4 _ <br /> Disposal Field: Distance from nearest well.....��_._Distance from foundation--- to nearest lot Zine-_ ..._...._ Q <br /> [ Number ofline's-________}" -----------------Length of each line____��� -_ Width of trench----- �'� ----------------�- <br /> Type of filter material__._ -Crl-_Depth of filter material___-- __-...__Total length........ <br /> Seepage Pit: Distance :to nearest well_ __/OQ.-.__Distance from foundation____ 0.__....Distan a to nearest lot line----.- ....... <br /> Number of pits---'g -Lining__= --Lining material--- -i 15--.Size: Diameter--- <br /> - -----__�f_.Depth.--.--- a��_ <br /> Cesspool: Distance fromn�arest'well-----------------Distance from foundation....----_-.__----_.Lining material..-_.______..._.____...._______.___._ <br /> ❑_ _: <br /> _- -- --------Liquid Capacity -----•--_-gals`Size: Diamete - Dth-- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.____...... _-------------.----- <br /> ❑ Distance to nearest lot iine------------------------------------------------ --•---------------------------------------------- ---------------------------- <br /> Remodeling and/or repairing (describe):-------------•---------------- --------•------••-•---------•--••----------------••---------•-----•--------------------------- <br /> �•--------• -----•--= - ----- -- - ---- �/- ----------------------•---•----... <br /> ir— <br /> y-- �------- ------- --.----� -...-. : <br /> f4r _ R � I -... 4-tom_...---�-- - ' <br /> I Hereby cert fy that I have repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St1. law and rules nd r gulations of the San Joaquin Local Health District. <br /> (Signed)------ ----• -------------------------------.-------• - - = - <br /> 'r - ---------------------------------------------------------(Owner and/or Contractor] <br /> By:---------------------=-•... -- ----- (Title)------------------- - <br /> (Plot plan, showing size of lot, to anon of•system_in relation_to.wells, build+ngs,_etc., can be-placed-on reverse_side].,: <br /> ti FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------TJ5 U`--------------- - ----------- DATE-.---- _ ---�------------ <br /> REVIEWED BY-------•-----`-------------------------------- - -------....-------- DATE-----------•--------------=-------------------------------- <br /> - - ------------------------------------------------- - --- <br /> BUILDINGPERMIT ISSUED,---------------------:-.:.:- -----------------_------._--------------....--------------------• ---DATE..--•-•-----------•----------- --------•-------------------- <br /> Alterations and/or <br /> ------------- <br /> --- --`..---i.r-r�-`-�-- �'�--- - <br /> recommend'ations------------------------------ � -- - -•---•-----•--••--••---------- <br /> "- - -------------1 __N---•--------•---------------•--------------------------------------*-------------------------*----------------- <br /> --../ ---- ---------------1" ----------------------------------­ ----------------------------------------------------------------------- <br /> ---.-------•-------•--------•---•-•--•------•--•-------------------•-•----- <br /> -- --•-- <br /> ---------------------------------------------------------- <br /> FINAL INSP -CTI N�.B _ - - ----------. . Date----- <br /> ,V 1.- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strut, 300 West Oak Street 124 Sycamore Street 205 West 9th Street ~ <br /> "'NStockton,California Lodi,California Manteca,California Tracy,California <br /> y <br /> E5 9 REVISED 8.54 ?M.5-62 ATLAS <br />