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APPLICATION FOR SANITATION PERMIT Permit No. ...../...2.17� <br /> (Complete in Duplicate) Date Issued _��141_/ <br /> This Permit Expires I Year From Date Is u d <br /> s <br /> San Local Health District for a permit f! col, k", <br /> Application is hereby made to the Sa n tr cf d install the work herein described. <br /> This application is made in compliance.with County Ordinance No. 549. <br /> /j-- -ry �/ �, - <br /> JOB ADDRESS AND LOCATION_ ___- --- ..........i------V1.11----- RK 0S 43b-_ '7 <br /> ---------- <br /> Owner's Name------ - _­4�-O_. Aleori_-*,�--- --------- ---------------------------------- ------ ----- -- Phone------------------------------------ <br /> ----------7At-_-_7Z--------------------------------------- ------------------------------------------------------------------ <br /> Address-----------or ---------- .......ael� <br /> Contractor's Name__ZVa__1------ -------------------------------------------------------------- ----------------------- Phone----------------------------------- <br /> Installation will serve: Residence ,v Apartment House E] Commercial F] Trailer Court E] Motel E] Other E] <br /> Number of living units: -1.____ Number of bedrooms 3___ Number of baths -_ Lot El size ---------- <br /> 0 <br /> Water Supply: Public system Community system E] Private Depth to Wafer Table _r ff. <br /> Character of soil to a depth of 3 feet:� Sand F] Gravel E] Sandy Loam E] Clay LoamZ Clay E] Adobe E] Hardpan 11 <br /> Ilk <br /> Previous Application Made: Yes E] 'No IN New Construction: YesjN No E] FHA/VA: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I'll <br /> Septic Tank: Distance from nearest well---, Dista �4 r foundation--./L ------ Maferial--- <br /> ---------- y __________________________________________ <br /> KI No. of compartments.......;------------------Sill-----�;e,450,0_'t-C---Liquid dep�h_..__ ------ <br /> Disposal Field: Distance from nearest well_v5�--------Distance from foundation.../2e_.........Distance to nearest lot line......J- ----- <br /> Width of trench- I., ------- <br /> Number of lines .,- ,--Length of each line-----70--------i---------- --- ---- ------- <br /> Type of filter Depth of filter material----A?--- .____Total length_tj: --- -------------- --------- <br /> oun <br /> Distance to neare�j we4A nA,10-04-_D�stance to nearest ------------- <br /> 5e e Pit: D an e aresf lot line--%S <br /> i'f m f 2-±* , ­*W_�----------------1 <br /> 'i, I -- ----- <br /> Number of pits--*" - ---------Lining m e e: Diarriefer—,XMI Dep <br /> Distance from nearest well------------------ist( f <br /> Cesspool: D 3 n ce rm "n tion-__ -- ---------Lining material-_._____.._____________________. <br /> ElSize: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity- -------------------------gals. <br /> Privy, Distance from nearest well------------------------------------------------Distance from nearest building- ______-------_ ---------- <br /> 171 Distance to nearest lot line------------------------- -------------------------------------------------------------------------------------------_--------------- <br /> Remodeling and/or repairing (de5crib e):------------------------------------------------------------------------­--------------------------------------------------------------------------- <br /> I <br /> ---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> ----------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------- --------------I------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and.-regulations of the San Joaquin Local Health District. <br /> (Signed)------------- ---------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:---------- ------------- ------------------------------------------------------------------ ----------------------- -----------(Title)----------------r------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ------------------------ DATE- 'f <br /> REVIEWEDBY--------------------------------------------- <br /> __-__/- -----I-------- -------------- <br /> BY--------------------------------------------------- -------------------------------------------------------------------------- DATE........ -------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------- 1----------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------1-1------------------------------------------------------------------I------------------------------------------------------1------------------------------------------------------I------------------- <br /> I <br /> ------------------------------------- -------­---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> . ...............1--------------------------------------------------- ----------------------------------------------------­-------------------------------------------------------------- -------------.------ -------- <br /> 3 0 <br /> FINAL INSPECTION BY4.9C,,,414_e-------------------------------- Date-- -----_------- ------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 8-'59 F.P.Co. <br />