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�.,.�.. — <br /> SANITATION PERMIT Permit No. ----- ------- <br /> APPLICATION FOR <br /> Qt 1 (Complete in Duplicate) , - Date Issued ___ 1 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. . _F <br /> JOB ADDRESS AND LOCATION---•--------a -. ri 1nSaRn r Phone-----H. 6 <br /> Owner's Name ---------------------------------------------- <br /> Address------ --------------------SAmP--•---------•--;----------------------------------:-------•----------------------------- HO 7 <br /> ------ <br /> --------------- Phone-----------•�----- -o4b <br /> Contractor's Name------------- NxGHT---`2EP'1' C__`i'-ANK---`7 `]RVICE---------------_------- , <br /> Installafion will serve: Residence ❑ Apartment House ElCommercial Trailer Court ❑ Motel El Other ❑ purtC <br /> tt ---------=-------------- <br /> Number of living units: 10-- Number of bedrooms 10- <br /> Number of baths -,I()- Lot size' ------X---- - • <br /> Water Supply. Public system ElCommunity system ❑ Private X Depth to Water Table __� {},- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ElClay Loam El. Clay E] Ado Hardpan C]Previous Application Made: YesXZ No ❑ New Construction: Yes ❑ No E] FHA/VA:Yes No ❑ Supplementary <br /> Drain <br /> TYPE OF INSTALLATION AND!SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> } <br /> Septic Tank: Distance from nearest weh-----------------D1Ztance from foundatiL quid depfih- Material------------------------------------------------- <br /> Septic <br /> -.----- Ca -city__.__--_-___-_-------- <br /> Oxisting NO of compartments_____ <br /> Disposal Field: Distance from nearest will______________ .Dista"n'ce from foundation______________.___-.Distance to nearest let line----------------- <br /> i57r1 Number of lines-----------------------------------Length.•of each line----------------------------i1xWidth of trench <br /> Type of filter .material------------------------Depth of filter_material---------------------.-Total length--------------------•---------•-------- <br /> Seepage Pit: Wi Distance to nearest well_"___._1,�1I�!----Distance from foundation__�Q�----------Distance to nearest lot line --__ �_;.---- <br /> Size: Diameter-----L+K!---------.Depth_-.- -3DI------------•--- <br /> Tq �n� Number of pits----2--------------"Lining material---FLOCk <br /> C��: Distance from nearest well------------ Distance from foundation--------------------Lining material__.--_______--_--__.___--____------ \ <br /> --Liquid Capacity <br /> gals. <br /> Size: Diameter--------------=---- ------- - ------De th-------------------------------------------------- <br /> El <br /> -------------------- -------------------------- <br /> ❑ nearest building------------------------------------------ <br /> Privy: Distance from nearest well-------------:------- Distance from <br /> \ <br /> ---------------- <br /> ❑ <br /> ----- <br /> Distance to nearest lot ine_�_'-_----------------------- -'----- <br /> _ <br /> Remodeling and/or repairing (describe): '?'� ______________ _ <br /> -------------------------------------- <br /> ----------------------------- <br /> t=--------------------------PP---- -•- - ---- _ --------------------------------------------- <br /> - aoul her eb certify the+ I''have prepared this application and that the work <br /> Heawill <br /> lbeth D done <br /> }n accordah�e with San Joaquin County <br /> y r es a d regulations of the San Joaquin Loc <br /> ordinances, State la>:'3:4' Iti�fGHT % <br /> (�r Contractor) <br /> SEPTIC TANK <br /> S15E YV -- ----- --------------- <br /> I <br /> (Signed).. X05 1�:.1�FI ""A"ve., S#ockton 5, Calif. - -----------(Title)---•--------------------------------------- ---------------- - <br /> By=-------_----------HOwafd�-, .0# ------------------ <br /> -- ---- ----- <br /> (Plot plan, showing size of lot, location oP system in.relafi tells, buildi s, etc., can be placed on reverse side). <br /> FOR EPARTMENT USE ONLY` <br /> APPLICATION ACCEPTED BY------ -- = ------- --------- ------------ ------------------ DATE 47 <br /> -� �� � DATE---t-- ----•---------------------------------------•------ <br /> REVIEWED BY--------------------- ------- - �- T <br /> DAT <br /> _ j <br /> BUILDING PERMIT ISSUED. - - IC f � , <br /> ------------------------------ <br /> Alterations and or recomm ndations:--- �r��)�s-----`,-`AA---- �, �+_c, '� L� --- o`c ---------------------------­------------ <br /> - _ - _�4�.._�---------------------•-----------•----------•---------------- <br /> °'� -- --`------- 4 E _ a h h <br /> ------------------------------------------- ----•----- <br /> ----------------- -------------- <br /> _____________Y__ <br /> _____________ <br /> Y -t ------------------------- <br /> FINAL <br /> ------- ---- ----= <br /> FINAL INSPECTION BY.,-'- - '----------------------------- <br /> SAN <br /> ---------------------- <br /> - ------------------ <br /> Date.... -- -- ----- ------------ <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> l30 South American Street - Manteca, California Tracy, California <br /> Stockton, California Lodi, California <br /> ES-9-20 - Revised 1-57 F.P.CO- <br />