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z <br /> -----------------------------•--------:------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> Z3 r [�rccx E (Complete in Duplicate) <br /> - Date issued --�� � <br /> -.� -.� This Permit Expires 1 Year From Date Issued <br /> 'Apphca+ion <br /> is hereby made to the'San Joaquin Local Health District fore permit to construct and��',��1istaH the work hetet descrbed. <br /> s; '�flis application is made 'n compliance with County Ordinance No. 549. � � <br /> �, J ;: <br /> OB ADDRESS AND L CATION._.:._ <br /> -Owner's Name3t -- ----•• --------•------ ----- •-- <br /> ` Address ............. Ph <br /> , <br /> T <br /> Contractors Name.-A9 r ' flk 1rf 1` <br /> r :_ ................................------•-- Phone....................... <br /> Installation will serve: -Residapca Apartrriertt House Commercial P <br /> ❑ ❑ Trailer Court� Motel.❑ Other ❑ <br /> lVuinbt3r of living units: )-•-___ Number of bedrooms _�__ 'umber Q1 baths _�... Lot s,ize'___. _, <br /> Water Isupply;""'Public system ❑ Comrhunity system ❑ PTavate ep+h To Wa+errTebie ra ft. �' l` t 4' 1°''? k C <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand Loam <br /> Sandy ❑ Clay Loc ."Clay ❑ Adobe❑ Hardpan Q <br /> Previous Application-Made: (If yes,da.t ._ Construction: "- <br /> _ <br /> 1. No New jYes ❑ '"FHA/VA: Yes ❑ No <br /> '. ` <br /> TYPEOF INSTALLATION AND SPECIFICATIONS: <br /> i # <br /> (No septic tank or cesspool permitted if public sewer is aveilable°within 2Q0 eet,} . <br /> rye` Imo# 1 Material-:= r _• <br /> 'Septic Tank: . Distance from nearest well------_----------Distance from foundatioq._=-�_-_--�-P.__ G;a act •. <br /> EEX15T/�6 - No. of compartments--------------------------Size----•-----------.__ ' L ui de th <br /> } `y F - �. r r --- P ty------------------• ' <br /> isposal Field: Distance from nearest we!!._�1"l _---Distance from foundation__,_ is+ahte }o dearest lot line__..- <br /> b'" _ <br /> , )C �/.f'�C Number of lines_.___- - ` •-- ----"""--Length of eachlline_ _r� __ I <br /> { ---- •----.Width of trench---•- <br /> ?,`�''� /qV 0 Type of filter material._, -"_"pep}h of filter Feat vial l ) "*--..-Total { Ul <br /> ,'. <br /> t t o <br /> Seepage Pit: Distance to nea:$ well__________- -- nil --_, -- <br /> Nu <br /> from foundation_.__: <br /> � s _..---•-•........ _Q <br /> ._ ._..____,__.Distance to nearest lot line_______ ___ <br /> ❑ Number of its Lining material. Size: Diameter -----------------------.... <br /> Cess <br /> Cesspool: 4 Distance-from nearest well .___ _Distance from <br /> --------- _CCC... <br /> -ri <br /> iz� , f`aundation- _______,_ -------Lining material____._ <br /> ❑. SizeC?iometer ..Depth------------ = Liquid Capacity_ l <br /> -•-------- <br /> Priv I t -- ---- ------ -w n egals,• <br /> „ r Y Distance from nearest we I __ <br /> �« .-. - -t•-r_.__ Distance from nearest building-------"----------------------- <br /> ❑ Distbnce'to nearest lot Ime_____ ___ """"""'"""" <br /> Remodeling and/or repairing (describe): , _ <br /> -------------------------- <br /> ----------------------•••--- r .. <br /> f = -----------•---------•: ----- -------------------•---------------------- <br /> --------------------- _ ----- -------------- <br /> -------•---------------- <br /> ------------------------------- <br /> -"----.. - ---------------------------------------- <br /> ereby certify that I hav prepared f is nplica+ion asld that the work will be done in-accordance with'Sari Joagtiiin County <br /> ordinances to+e law and I s and r gulation' of the arr`Joaquin Local Health District. ' <br />"--; (Signed " " <br /> .� ------ --- _ er` n r��Co� -.tractor <br /> BYM.. ­'._._.____,.___.22.;__: c C; -- --------------------------------------------------rile_ . ___�Y_ _{ `.n—a_door <br /> _. <br /> (Plot plan, showing size of lot, locationta stem in relation o wells buildings, etc., canbeplaced on reverse side*. <br /> sY :'I". <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_______,"_ <br /> n----------------------•--------------- ---- -- ---- DATE.._ _. <br /> VIEWED BY.. <br /> ------------------------------------------------------------- <br /> -;; <br /> --- DATE--------j y <br /> BUILDING PERMIT ISSUED --------- - <br /> • - .... .. r_a�r�--a..�...�.�_--...jai:::,:..'.::.s.�i:.,- :'�F':.=wh:•- <br /> r : <br /> Alte <br /> I. <br /> rations an or recommendatwns:._. ___________ __ _ _ ---r �------------------------------------------------------------- Z % <br /> "- -----."-----------------•---- _ <br /> ------------•------•-----... <br /> ------------------ - ----- -- - ------ .. ..... <br /> -- -- -----------------------_--------------- ------------ <br /> ------------------ ------------ -------------- -------- <br /> FINAL INSPEC BY- <br /> ---------- Date._, .._ _. —,, . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Stmt <br /> 205,West'9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> ES 9 REVISED a-59 2M 8-62 ATLAS <br />