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FOR OFFICE USE: <br /> Permit NO. <br /> ------ ---------- PERMIT <br /> !APPLICATION FOR SANITATION <br /> FOR <br /> OFFICE <br /> _E_`S-E- <br /> - -------------- - <br />--------- -- _ ` - -- --- ------------ <br />- -- - --- ------- ----- --- --1i -- - ------------- (complete in Duplicate) Date Issued 0 '1 issued <br />---------------------------- --------------------------- 1 year From Date <br /> - -------- ------!--- E ' - <br /> ------- ----- -- ------------ -------I----------- This Permit x fires it to construct and install the work herein described. <br /> by <br /> Application is here made to the San Joaquin Local Health District for a pe I rm <br /> This application!!is made in compliance with County Ordinance No. 549. <br /> Va4uov <br /> (*"97 <br /> " ;4et4aAw <br /> 4 ev Z/- <br /> JOB ADORES S!XD LOC 10 Phonec-_I-A­A_Z_��Z�_ <br /> -------------------------------- <br /> --------------------- <br /> ---------------------------------- <br /> ............ <br /> Owner's Name.� ................... ......... <br /> ................ <br /> ............................ <br /> -------- ... <br /> Address............ .... ....0 7....... <br /> ....... Phon <br /> U <br /> ----------- ............ <br /> Contractor's N ame----------------- ------- ------ ------- Trailer Court;'❑ Mote] 0 Other 0 <br /> Residence Tr.�Aparfment House 0 Commercial El <br /> Installation will serve: hs ---/. Lot size ------- -------- <br /> Number of bedrooms -:A-. Number of bat <br /> Number';of living units: ft. <br /> 1 9 <br /> 0 $ private in�bepth to Water Table <br /> Water Supply. Public-system ❑ Community system ❑0 5 - lay'[3 Adobe 0 Hardpan 0 <br /> i� 1 Sand Loam gj-'tlay Loam 0 C <br /> depth of 3 feet: Sand E] Gravel 0 Sa Y <br /> Character of $611 f0 a 5 - Uj--FHA/VA: Yes ❑ No 0 <br /> 1; it ,No Ej New Construction- yes [] No <br /> Previous Application Made: (if yes,date-------------- <br /> ALLATION AND SPECIFICATIONS- <br /> TYPE OF INSTALLATION I RN 200 feet.]ewer is available w, in <br /> (No septic tank or cesspool permitted-i _public s. <br /> Material------------------------------------------------- <br /> nk,, Distance from nearest well-----------------Distance from foundation' . ..........Capacity...................; <br /> n Size---_-----------------------"-.Liquid depth------­-------- <br /> i� No.' of compartments-------------------------- f <br /> nearest lot line----4�....... <br /> /10-0......Distance to ne ;.7 <br /> ODisposal Fi d Distance from nearest well-SO-------Distance from foundation..' ................. <br /> -Length of each line_/ <br /> / OA2............;......Width of tren c <br /> Number of,lines - ------Total length-_-" <br /> Depth of filter material___- <br /> / <br /> Type of filter material-'s'- arest lot line_----_-------- <br /> 4.est well-----------------------Distance from foundation....................Distance,to ne ----------------- <br /> ed Distance to near ............Size- Diameter-----------------------Depth---------------- <br /> Number of pits.. :---Lining material----------- k I, t' <br /> aterial------------------------------------- <br /> -------------Liquid Capacity----------------------- <br /> from foundation_____ ------__.------.Lining material_______..__.__ <br /> Distance from nearest.well-----------------Distance .....gals. <br /> C <br /> ------------- <br /> Size. Diameter-S•----------- -----------Depth--------------------------------- <br /> 0Distance from' nearest building----------------------------------------- <br /> Privy: Distance from 'nearest well----------------------------- A -_-1---------------w------------------------------ ------------- <br /> ----------........ <br /> ------------ <br /> Distance to nearest lot line--------------------------------------------------- -- <br /> Ej I I <br /> i ----------------...................... <br /> I I -------------------.............. -------- ------------------- <br /> odejijng:�and/or repairing (describe)........ ------------------ ------------- <br /> Rom -------------------_------------_-------_----------------------- -------------- <br /> ---------- -------------------------_ <br /> =-------------------------------------.7--- -------------------------- ------------------ ----------------- <br /> ------------- <br /> -------------------------------------- ---------------­------------------ -------------------------------- ---------- <br /> --------------------7 --------------------!----------------------------------I--------------------- with San Joaquin County <br /> ------------------------------------------------------------ <br /> I hereby certify that I have prepared jet <br /> application and that the work W�4111"bg d6ne in accoMi`nce <br /> I lations of the San Joaquin Local Health District. <br /> crdinances,'$ laws,s, a nd ules and re <br /> ner and/or Contractor) <br /> .. ........ ------- <br /> 'A 'y ix/ -------------------- ------- <br /> ed)--- --- ------------------ - <br /> [Signed)-- ----------t�_ <br /> --------------------(Title) <br /> -By: ............................ d on reverse side). <br /> well uildings, etc., can be place <br /> plot plan, showing size Of 16t, location of system in relation to <br /> FOR DEPARTMENT USE ONLY <br /> ir <br /> ------- --------- <br /> --------- DATE_.------- Y----- <br /> - ---- <br /> BY----- ---------------------------------------- --------------- DATE ---- -------------------I-------------- <br /> ---- - ------ <br /> ---------------------- -------- - .......................... <br /> ............... ------- <br /> REVIEWED BY---- ----------!�---------- ------------------- DATE--------------------------- <br /> BUILDING'PERMIT. ISSUED---------------- -------------------------------------------------------------- . ...... --------------------------------------------......... <br /> Alterationi and/or retd�nmendafions:--------------------------------------------- -------------------------------------------- <br /> --------------------------------------­--------------I-----------------m�............... <br /> ............... ­----­--------------- --------------------------------I-------- ................................... ------------- <br /> --•------ <br /> --•-` <br /> ---I-------- <br /> ...........I---------------­ . ------------------------ <br /> 11 1. 1% ------------ ---------------------------------------------------------------- <br /> ............... -------------Z------------------------- -------------------------------------------------1-1----------_----------------I----------- <br /> 0. X/------------------------A------------------------------------------------------------------------ - ----------------- --------I...... <br /> ---------------- --------- ------------------------------I--------------------------------------- ---------------------------------------- <br /> ------------ ---------_.­- <br /> ------------------- <br /> Date...... --------------I............ <br /> -------------- - <br /> INSPECTION INSPECTION BY: ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 west Oak Street 124 Sycamore Street <br /> Roy West 9th STT**t <br /> 130 South American Street Iracy,callfornla <br /> .1 Manteca,California <br /> Slockt-11n,California Lodi,California <br /> .1 1 <br /> ED 9 REVISED 0-69 2M 5-al ATLAS <br />