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;�rrlk_r UZ)t: <br /> ---------------------------------------------------------- <br /> ---------------- --------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------_--------------:------------- ...�221 <br /> --- - --------------------------------- I (Complete in Duplicate) ITV <br /> This Permit ExicesI Year Froin, Dale Issued Date Issued ---------- <br /> Application is herebyI <br /> made to the San,Joaquih-\Local Heal+h District 11 the work herein described. <br /> for permit to construct and insts <br /> This application is made in compliance"with County Ordiriance No. S49. t <br /> JOB ADDRESS AN i I I V,e�k <br /> D�LOCATION.,.,__. <br /> - - ------- S_77� 9 <br /> Owner's Name.--._. tj -----------_----IVANM��7 <br /> 8-8-Laww---------- IcEoap�, <br /> Addres ----------- one-' <br /> • <br /> .......... - ----­------- --W/V T:P_-.CA <br /> -- --- ------------------------- <br /> Contractor' n. ---------- .......................... <br /> Contractor's Name_bN 7 1 <br /> _[ =---- <br /> ......................... !Phone.Z...,....................... <br /> Installation will serve: i'Residence C] Apartment House F _i <br /> _] Commercial 0--frailer Court 0 <br /> Number of living Mofel E] Other El <br /> g units: er of bedrooms Number of baths — <br /> .4--__Num -S <br /> --- Lot size ---- <br /> Water Supply: Public jLysten4t& AC- <br /> y sysf P��Private F1 Depth Water Table <br /> Character of soil to a depth if feet: 4'San! Lci Gravel E] Sandy Loam WClay Loam E] Clay El Adobe 0 Hardpan <br /> ❑ <br /> Previous Application Mlacle: �)'f yes date... te ----- No YT."'New Construction: Yes <br /> --- No E] FHA/VA.: Yes <br /> —TYPE;OF-INSTALLATI't)N iAN0�JSP'E;CIFICAT'1ONS: <br /> (No septic tank�or ltesApool permitted if-public sewer iso-available <br /> p within 200 feet.) <br /> nearest well <br /> Se tic Tank: Distance 40m, I I , --- c 6� r6Mfoundation--------- <br /> .JE7y N 6— No of coringa ------- --------Distance -----------Material------------------------------------------------- <br /> rfm'bhf5 4 <br /> -------------Size- <br /> r Liquid depth_------••--------------. Capacity-----------------_---- <br /> ------S_ Distance-from-foundation----- r......Distance to nee rest lof'rline <br /> Disposal F, Id: Distance fjorn aearde <br /> Nukiber o Ides I <br /> ----------- ength of each line-------- y-7.......Width of trf�nch...... <br /> Typte-of 1j(tefma_`_.`_ri_a--- ------ <br /> rt=%pI ILT-EIR I-- JtW-6f--r, <br /> . I - __ - --- -----Total length-..-_..------- <br /> t, Di! ------------------ <br /> F rel ------ <br /> well-------,5_ZPty'Dist.`qZ�etLrom foundation------IC------Ditance to nearest lot <br /> Numbee40f­P1ts­_'i-!---/-----------Linii a -.v- Size: Diamefer4V_xae_,.Depth----- <br /> tz�- ---; -- --------------------- <br /> aresf well- 'Dist Jo-u n d a t' <br /> �g <br /> Cesspool: I)Jance*�rem nearest ---- --------- anc <br /> El S;ze: Diea <br /> —-------lining material-------•--- <br /> # -------------- <br /> ---------7_6;th-----I <br /> --------- ----------------------------- -_-Liquicl Capacity <br /> Privy: :if i --------_------------- <br /> Distance from ne'i0est well---1 _1­7��j 4 --- <br /> ❑ Z n-_ . I------- -------Distarace from earest building--------- <br /> Distance tonearest: lot line -----------f --------------------------------- <br /> ---------------------!��A <br /> .-i y-----------------------------------------------I---------------------- <br /> Remodelling and/or repairing {describe]:-_------- ------------ <br /> 1 <br /> ........... -------------- ---------It :1 --------------------------------------------------­--------7- ------------------------------------- <br /> ­-----­------------------I--------------------------------------------------------- <br /> -------------------------------------- --------------------t,_------_-----------------*---------------- <br /> ----------------------------------------------------------------------------------- ---------------------- <br /> - ------ <br /> - --------------------------------------------------------- <br /> -------------------------------------- <br /> ..............- ----------- -------- <br /> I hereby e if th -------------------------------------------- ----- <br /> - ----------- <br /> e prepared this application and that the(work will be done in nce'-with--San-'Joaquin--County <br /> - <br /> 9 <br /> ordinances. 0 s nd a e a 'egu' cf <br /> egulafjons of_fhe San Joaquin Ucal Health Disfri <br /> (Signed)----- --------------- .......... 1 <br /> ---------- --- <br /> --------------- r ir� <br /> ------------ 41 <br /> By-:--------­-------­A.--- -I -------------------------- -------•--------(0 Contractor] <br /> __-1----------7-! Title ,to.40t t�'4, <br /> (Plot plan, showing size ---- - <br /> ------------------------------------------------ ----------(Title)---------- --------- _711.7t <br /> of 10 rotation system in relation to wells, bdildings, etc., can be placed on reverse -------------- - -------------- <br /> t si <br /> FOR - -K___ ONLY <br /> USE ONLY <br /> APPLICATION ACCEPTED BY----._, ,`"- '" <br /> REVIEWEDBY --------------- ---------I--------------------------------------- DATE-------- <br /> --...-----I•-- --------- 11% 7-------- --- •, <br /> -------------------------- ------ DATE <br /> ---------------- <br /> ------------------------------- <br /> BUILDING PERMIT ISS' <br /> ---------------------Z------------------ <br /> Alterations and/or rec � mencrafions:_Af % Z----------------------------- DATE.-..-,----------------------------------------------........ <br /> o!" - ---------------I------------------�k-------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ----------- --------------) "k <br /> ---­---------- ---------------------- ---------••--------•--------•--•----- -------------------------- •-------•-••--------••------•----•--------•---•-••- <br /> -- -----r;,.�---------------­------------ ----------------------------------­-------------------- <br /> -----­---­----------------- ---- _1 11 <br /> ............ .. 1.1 ---------------------------------- <br /> ------------ ... ... . <br /> ---------------_--------- ... ........... ------ ----- -- ---------------------------------------------------- -------- ------- ------------------------------------ ----------------- ------- - I---------------------------------------------------------------------------------------------------------------------- <br /> FINAL TIONcn__ tA <br /> ------------- ------------------- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> 300 West Oak Street 124 sycamore Street <br /> Stockton,Cafffornia Lodi,California 205 West 9th Street <br /> Manteca,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS Tracy,California <br />