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F R OFFICE USE: ( e <br /> y ---------.- <br /> r i Permit No. <br /> _ {_ c-l{ G':Nl.__ APPLICATION FOR SANITATION PERMIT <br /> ------------- ------------------------ (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <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 /> r ........... <br /> JOB ADDRESS AND LOCATION r� � �� -� A ------ •-•-`---- ------------ <br /> Owner's Name....------ <br /> fi�ieP.�• c� %.Ljl --- Phone............................-------• I <br /> , <br /> � _D, -- ----•- ------------.......................................................... <br /> Address :- ••. . --- <br /> -•---- •-• •- <br /> Contractor's Name....---•-rte.. - ____ _ �____ •-•............. Phone%�4oDT.— "��$ <br /> e�r�rc.0 G� <br /> Installation will serve: Resi once partment House . Commerc ❑ ' railer Court C] Motel [I Other ❑ <br /> Number of living units: 4-- Number of bedrooms -I/- Number of baths .__-I, Lot size _________________----------------------_---_------___----___ <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth TO Water Table -------- ft. <br /> Character of soil to a depth of 3t feet: Sand E] (Gravel ElSandy Loam ElClay Loam ❑ Clay ❑ Adobe 2__T�lardpan [I <br /> Previous Application Made: (If yes,date---------- "_-_._l "No ❑ New Construction: Yes �lo ❑ FHA/VA: Yes ❑ No ®-"" <br /> TYPE OF INSTALLATION AND`SPECIFICATIONS: a- <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--------------------Material------------------------....;---------------...-- <br /> 1 <br /> No. of compartments--------------------------Size------------=-------------------Liquid depth------------ --------------Capacity---••• -------- <br /> � . T w <br /> sposal21�'d: Distance from nearest well- c�tC___Distance from foundation...__Z _Distance to nearest lot line__ <br /> Number'of lines.............. ------------ ngth of each line_______.-+3-7-J __.. ----Width of trench.._____.._ _. . --� <br /> �� _ i <br /> Type of filter malterialr��tlT�.C_/!C�` epth of filter material____ ______Total length__._..._.__. __ ______________ <br /> __________Distance from foundation---- to nearest lot line--------.-------- <br /> Seepage Pit: Distance fie nearest well-___________❑ Number of pits.1-------------------Lining material-------.--.-4 -------Size: Diameter-------- <br /> Depth----------•----------•-••------ <br /> earest well------- <br /> ----------Distance from foundation._-_.____-_____._-.Lining material-.____.____-_______._______----.___.- <br /> Cesspool: Distance from n❑ Size: Diameter_ I - -------_-Depth------------- '------------- -------------Liquid capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------,------Distance from nearest building------------.---------------------------- <br /> . <br /> ❑ F ` <br /> Distance to nearest lot line--------- ------ " •------•-•---------------...-----•--------- -----•---•----•---------•-------- <br /> ( 4 <br /> -woo- <br /> Remodeling ---------------------------------------------------------------•-•-------- <br /> Remodeling and/or repairing (describe :-------- ---------- -------------- --------------------------------•- <br /> i x_ "1 <br /> f I Vn <br /> ------------------------------------ <br /> f', <br /> ._______._________._..___._.____._____________.-------------- <br /> _____ ___ _ ______ ___ - _ __-_____ __.._.______.____.._____.___ -____._. ------_.------_---____-------__-----__----______.____---__ <br /> ___________ .. <br /> r I here_ by_ __ __ _. <br /> certify th_at_____ __ <br /> I have pr_epared this app licati_.__ ..on and that_"the work will be done in accordance with San Joaquin County �} <br /> i ordinances, State laws, and rules and- - ulations of the San Joaquin Local Health District. <br /> A7, <br /> ,� <br /> (Signed)_ Vii.-�----------'---------- -----� Ctr----•- �--------------- --�--•-----{Owner and/or on actor) <br /> ' _ - ---------------- Title ------- --------- <br /> (Plot plan, showing size of lot,-location-of 7system in relation tom ells, buildings, etc., can be placed on reverse side). <br /> ti <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY______________ _______ _ -GQ�---------------------------------------------------------- <br /> J,f <br /> I R ` --- - - -------------- DATE}.------��-,�,1-=--,�- -•-------------- <br /> --- -- - ----------------------- - <br /> REVIEWEDBY----------•------------------------ , DATE-----------------------------------. ----------------------- <br /> DATE -BUILDING•PERMIT ISSUED------•-------------------- -- -----------f---------:---- <br /> -------------------- <br /> Alterations and/or recom ndailons-__-- _ ----- - -------- --------------_------------- <br /> ,. .. _._ <br /> ----------­--------------- -------- -------------------------------- ........7_7------------- --------- --------------------------------- - ----------------------- <br /> ` - <br /> - � <br /> ! �y-- -----•--------------------- <br /> j FINAL INSPECTION BY:..- ''' <br /> aSAN ------------- ----- Date..- .- .. .JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-S9 2M 5-62 ATLAS - <br />