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f VJ[- 7 <br /> -------------------------_._._-....__..___.____.____-_.__ APPLICATION FOR SANITATION PERMIT Permit Na. ._..�.�.�-�' ..� <br />` • ---- ��I(Complete in Duplicate) <br /> ---------- ----------------- --- Pq,is- Permit Expires 1 Year From Date Issued Date Issued ..... <br /> 2 zf- -r-7,0_ y <br /> Application is hereby made to the San Joaquin Local Healfh 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 /> ,2, 302.5' -- <br /> JOB <br /> JOB ADDRESS AND LOCATION---- ICKTaI l-l->.......... <br /> Owner's Name Y1 F_ ah?r__ _!k2 R---------------------• --- - ------•------•------- Phone-----•_._........................... <br /> Address------Rml�- --- {—'L.. S'-x.......6-1-7....-'...R1_f?�t..._..----- ------•----- ............................................................... <br /> Cjillontractor's Name-------- r-fir.-_ �1� " ' -----•i`-�-n _Y�!- _!\f ....... Phone.....................-----------•- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1.... Number of bedrooms "3- Number of baths 7�-_-_. Lot size ____�-�w?; .�..�(_..._ _ ..�.............. <br /> Water Supply: Public system ❑ Community system ❑ Private E�r Depth to Water Table .;?C' ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam O'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No Er New Construction: Yes No ❑ FHA/VA: Yes e— No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well._. ` Distance from foundation---Z ......__.Material..�Ctl%1 ` ••: s^ <br /> No!'of'coni arfFmts..______ <br /> P e Slze._.;K1 xLiquid depth Capacity ( i..�-��5 <br /> F <br /> Disposal Field: Distance from nearest well___-6Q___.._Distance from foundation__ 1.0- to nearest lot line___-__J—___-.- W <br /> E' Number of lines....... _____ __ Length of each line_6!2- ___= �I .Width of trench..,�Y"------ - - <br /> Type-of filter material.. -C.# ------Depth of filter material___-� ._t________._Total length....... _ t... :............ <br /> Seepage Pit: Distance to nearest well___-------------------Distance from founclatio __......!..........Distance to nearest lot line__............... � <br /> ___4 a� <br /> ❑ Number of pits : Lining material-------------------- e: Diamete�... ;-----Depth-------.....--- ••----......_ <br /> Cesspool: Distance from nearest well-----------------Distance from undation---------------I"":Lining,material..............-.____.__-_----..-•--__ <br /> ❑ Size: Diameter-------------------------------------Depth--- •----------------------------- --------------Liquid iCapacity............................gals. <br /> Privy: Distance from nearest well---------------- <br /> Distance from nearest buildin 7.._________-_ <br /> ❑ Distance to nearest lot line----- . -------------- 1_:__- ----.•---_-. <br /> n _ , Q <br /> Remodeling and/or repairing (describe=---- <br /> ----------- --------- -��!�{�* �.�'���'.�.,.-�-•----�7�.�---1'-T�_. <br /> . 1A4 <br /> �- -------------------------------------- <br /> X _.m }hat l avis prepared h e licati n t +fhle work�w��il be d�iNin ------ dance A .....Ivy <br /> -...�E <br /> herebycertify P P PP h San Joaquin County <br /> ordinances, State laws, and rul f�l M_s and regulations of the San Joaquin Local Health District. Mt <br /> - - T Jj.0 <br /> (Signed)...... ///-_----- T7. °-------- ----------------------------------•----------------------------------------(owner and/or Contractor) <br /> (Plot plan. lot, location of s stem�in'relation to'wells, buildings etc.-__can(bele'laced on r- --_____._d ). <br /> ( P .,� f Y � � ._ 9 � p averse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -'- '- - ` DATE-•---I9_- <br /> - -- - -------••------------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE--------•-- <br /> BUILDING PERMIT ISSUED--•---------------------------------•------•---------------------------•--•------------------------- Df4TE.--------•----------------•-•----- <br /> AlFerations and/or recommendations------------------------------------------------------------------------------------------------- <br /> ------------ ............................................... ---------------- ------•------- <br /> :..: _.-�=----------12Z <br /> -t Y_..-. ___.�_.... ... --- <br /> --------------------------1-1------- <br /> ­­------------------ ----------- <br /> FINAL INSPECTION ------ Date------�._-.�.�`-.�Z--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 30 South American Street 300 West Oak Street 124 Sycamore Street r <br /> y 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 ReVISEG 8.59 8M 5-61 ATLAS <br />