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s <br /> FOR OFF1C VSE: , <br /> f/p �7 <br />------------------------------------------------ <br /> - <br /> APPLICATION' AOR SANITATION PERMIT Permit No. .. ................... <br /> (Complete in Duplicate) <br /> ___.___ This Permit Expires l 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 install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCAATION._11,t /� �' _--•-------••---------"------....._"---._.... <br /> � A �--XOi-.----j1 jeV`--- _414 J�� . <br /> Owner's Name ls'J --- -----• Phone................................... <br /> Address.........AN..---.e .�_-"74-------- •��1.0 A�1""--•------------------------•----..------"...."-"---"-------"--...----"-----------•-•-----.....------. <br /> Contractor's Name--------------{ .�- rrX0%7 E <br /> � - _ "1.0-----_------------------- ----------------------------------------------------- Phone................................... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ <br /> 15/Number of living units: `"'.. Number of bedroomsNumber of baths _ _ Lot size _JA ��...................................... <br /> Water Supply: Public system C1 Community system ❑ Private Depth To Water Table ------ <br /> Character of soil to a depth o43 feet: Sand ❑ Gravel ❑ Sandy Loam Ir Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------I No g?"New Construction: Yes ❑ No J�T' FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o <br /> l�Q Material--- �r_tQdf"`- •-- ------------- <br /> Septic Tank: Distance from nearest well _ A0___Distance from foundation__- __ <br /> �' No. of compartments__. y----...��___-----_Size AXAi _Liquid depth_..__JV_____.__._.._--Capacity. __.-. <br /> Disposal Field: Distance from nearest well-AM. Distance from foundation'..f ---Distance to nearest lot line.., �.... I, <br /> Number of {fines________ _____ ______________ Length of each line__-!Q� Width of trench. __.------ ---.___._______-.-- <br /> Type of filter material. Depfih of filter material... .-._-------Total length______� _______________________ <br /> See pag Pit: Distance to nearest well----/�Ap-----Distance from f undation_... � <br /> !__....Dist`�e to nearest lot li�.�"______ <br /> Number of pits-----A------------Lining material_ ----Size: Diameter,.?'-�_.__-_____-Depth__nnif.-------------------- <br /> Cesspool: ';. Distance from nearest well-----------------Distance from foundation--------------------Lining material--------....______..________....____. <br /> " --•.Liquid'Capacity :--• ---gals. <br /> ❑ SizeDiameter De th <br /> p __ q I P tY- ;--;. <br /> Privy: )Distance from nearest well_____...__________________________--------------Distance from nearest bui.lding--------.-------_-, .....___._._.______. <br /> ❑ Distance to nearest lot line------------------------------- :- - ---------•--------------- i <br /> I <br /> Remodeling and/or. repairing (describe):------------------A - "- ----4-4.4 - -------------------------------------------------1-f--_-;---:-­----._-­-----------_-_--:------_-_-.- ----- ------•-----------•--••-------------......_------- <br /> -------- <br /> -- <br /> ----------- <br /> r -.___..��.., , . _.. ---------- .----------- ------------------------------------------ <br /> -------- ....-.---------------­---------------------------- <br /> 9 w $ =-•-----------=--------•-•--------------------------- ------ <br /> -------------------------------------------------------------------•- --I—-------------- ----------- :•--------------------------- <br /> I hereby certify that I have prepaFed this.application and'rfliat the work will be done in accordance.v4h 5an•Joaquin County r! <br /> ordinances, State laws, and rules a regulations=of-the San Joaquin Local Health Distfiicf.�-.. 1 <br /> ... --- "' - -- --- r Contractor) <br /> (Signed)-" r ------------------- <br /> ---- <br /> --•---------- - <br /> } <br /> I ---- ---- T',#le <br /> - -------------- ---- = ( I 'y <br /> (Plot plan, showing size of lot, location-of system.in..relat' - ..o wells,-buildings;.etc., can be;,Placed on reverse side). I <br /> PARTMENT USE ONLY,,: <br /> APPLICATION ACCEPTED BY.--- --.� - -E*-�----- -- ------------------------------------"--- DAT ------------------ <br /> REVIEWEDBY------------------------------------ --------------------------------------------------------------------------------- DATE__;:.------------------------------------------- ------ <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- ---------- DATE <br /> Alterations and/or recommendations:--------------- ---------- ------------------ -----••------------- - --------------- ............------J-/,/S <br /> .. _______ <br /> ---------- .._.__ f--��T.r/6.�-....=_�Y.__..-. _1 _______________________ <br /> 4 <br /> " - --- j------ <br /> P <br /> z .:_......�_`__{ er� s�- �'f ------- �/ ... ---------- <br /> ------------ <br /> -------••-------------•-------------- -------------•-•-------- <br /> 1 -------•----------••---- ----------•----------•-------------------------------------------------•-------- <br /> F <br /> FINAL INSPECTION BY------ -------- Dote......_ ---------- l ------- <br /> ;i --------- ---- - - - <br /> SAN:JOAQU.IN LOCAL HEALTH DISTRICT <br /> 130 South Amerkan Strut '_ 300-West Oak Strew i14'Sycamon 5fnat 305 Wast 9th Street <br /> Stockton,Califor 10\1 Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M'5662 ATLAS <br /> i Y ' <br />