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FOR OFFICE USE: <br /> --------------------------- ---------- Permit <br /> APPLICATION FOR SANITATION PERMIT <br />-- ---------------------- -------- -------------- <br /> -------------------I-------------------- (Complete in Duplicate) Date issued .... .j� <br /> I This Permit Ex1pires I Year From Date Issued 0�3_ <br /> ------ ........ ­------------ f _ <br />.. ............... ...:.:�. --i t d-instaft�eF rk�erein described. <br /> Application is hereby made to the Sari Joaquin Local Health District for a permitn <br /> This application is made in compliance'with County Ordinance No. 549. - ;,r <br /> -------------- �Z <br /> JOB ADDRESS AND LOCATIONA&_,5' e _j6-------15,12tAl...... ----_-------------------- <br /> A ------------- Phonvk' <br /> Owner's Name—eOW-L,----------_----70-101.141-w-ly --------­------- --------------------------------------------- I <br /> - <br /> - 9- 2-g) ----- ----- - t, ----------------- <br /> -------------------------- <br /> Address------.-------------- --------------------------- ---------- ----------------------- ----------- <br /> one ,� <br /> Contractors Name-------- --------------------- -------- , <br /> r Court 0 Motel 0 Other <br /> Installation.will I serve:. Residence F1 Apartment House 0 Commercial [I Trailer - <br /> Lot size -------- .404FA-----­-------- <br /> tNumber.of living.units!%*_�Number of bddroome%_, Number of baths <br /> I _V0__ ft. <br /> Water Supply: Public:.system n Community system 0 Private " Depth To Water Table 1_�' ___N,-, <br /> I Sandy Loarn.EEI�Clay Loam [5'*' Clay C] Adobe 0 Hardpan 0 <br /> Character of soil to a depth 3 feet: San� [3 Grove! 0 <br /> , 1� - .. — - - I - No El <br /> I ET""No [] FHA/VA. Yes El <br /> - _1 No �<Nw Construction: Yes <br /> Previous Application Made: (If,yes,dGte----- --------- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- available within 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is <br /> Septic Tank- Ko Distance from nearest well-----------------Distance from foundation--------------------Mat'erial------------------------------------------------- <br /> V No. of compartments-----------•---------------Size-----------------------------.--Liquid depth-------•-----------------Capacity..--------------------- <br /> Disposal Field: —Distance from nearest well.... Distance from foundation.....-*.!P!.........Distance to nearest lot line.--- <br /> y <br /> -----------Width of french -----------_ <br /> Number of lines--------------- -------------------Length of each line-; .. .. ---44 <br /> Type of filter maierial./� ... -Depth of filter material__-. -_----.--Total length_-__..._-.7—--------------------------- <br /> -.Distance to nearest lot line_--.X <br /> 0 ? -----Distance fro m foundatio ...... <br /> Seepage Pit: Distance to nearests ell._/ material--eV - ....�Z- ------------- <br /> F <br /> Size: Diameter-------c!?3, Depth--.--_-_"- •'--- <br /> Number of s---- - --------------Lining m <br /> A <br /> Cesspool: Distance from nearest well---------------_Distance from foundation--------------------Lining.material------------------------ ------ --- <br /> 4 - -7-_-Depth------------------------------------------------I....Liquid;Capacity..----_--------­----------gals. <br /> 0 Size: Diameter--t------------I--------------­ i <br /> lafest well-- -_;--------------------------Distance from nearest building------ ----------------------------------- <br /> Privy: Distance from n, ------ 1 4� -------------------------- ---------- <br /> ------ ----------------------------- <br /> Distance to nearest lot line------------------------------------------------------------------- k <br /> ❑ <br /> 7 <br /> S <br /> .......... <br /> Remodeling and/or-repairing (descr ------------------------------------------------------ <br /> .......Fee <br /> ..................I---------------------I------------- --------------- ----------------------------------------------------- ---------------------------------------------------------------------------------------- <br /> , _---------------------- --------­-----------I---------I------------------------------------------------- <br /> ---------------------- ---------•------------•_-----•-------------------------m__: ----------------------- -- <br /> -- - <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, Slate laws,11 and rules and regulations of the San Joaquin Local Health District. I r <br /> ----------§ ----(Owner and/or Contractor) <br /> (Signed)_ - <br /> --------------0-,-. <br /> (Ti --------- <br /> - <br /> -------- <br /> By:---------------�06151`�_. ------ .: <br /> ----------------------- <br /> (Plot plan, showing size of lot, location osystem-in --------- <br /> -t ;elation to wells, buildings, etc., can be placed on reverse side). <br /> f in <br /> FOR DEPARTMENT USE ONLY <br /> - - - ------------------- DATE_A_ ------------------------------ <br /> APPLICATION ACCEPTED BY ---- DATE---------------------------------­ ---------------------- <br /> REVIEWED BY--------------------------------------------- ------------------------------- <br /> ---------------- DATE---------_---_------------------- --------------------- <br /> BUILDING PERMIT ISSUED-_---------!_-----------------7---------- ----------7------------------------------- <br /> ---------------------------- -------- --------_------------------------------------------------------------------ <br /> iior�s <br /> Alterations and/or recommencta. I ----------------------------------- -------- ---------­------ ---------------_-------------------- <br /> -----------------------------------------------------------------------------_---- ----------------------------------------------------------------------------- -------------------- <br /> ------------------------------------------------------- ----------------------- -------•---- ------------------------------------------------I—I-------- ------------------------ ------I" <br /> ------------------------------------- ------------------------------- -------------------------------------------_-----_--- <br /> --------------------------------------------------........ ----------------------- ­-----I-------------------- ------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------- ---------------------- <br /> 1011 Date----- <br /> _------- .Y--e- -------- ----------- - -------------- <br /> FINAL INSPECTION --------------;------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 wait Oak Street 124 Sycamore Street 205 West 9th Street <br /> 130 South American Street Lodl,California Manteca,California Tracy,California <br /> Stockton,califorrilo <br /> ES 9 REVISED 8-59 21A 5-62 ATLAS <br />