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AI-Oi"R QFFI E UgE: <br /> - . 17a/v..---/,- <br /> ------ ------- ---------------- ------------------- APPLICATION FOR' SANITATION PERMIT Permit No. <br /> ...5-C <br /> ------------_-"---------------------------------------- (Cornplefe <br /> ----------------------------------------- <br /> (complete 4'n Duplicate) <br /> -------------I---------- .......... ----------------­--- This Permit Expires-I Year From Date Issued 1-7 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,wifh-Coun-ty-Ordinance No. 549. <br /> JOB ADDRESS AND LOCATK:5N <br /> --f- ---- <br /> ---- ---------------------------------- <br /> Owner's Name______________ f_1 L. A_111*qL,-j2 ------------k-------------­--------------- <br /> Phone............... <br /> ---- -------------5:1.00 ---------- <br /> f '014 <br /> ----- --;? W---424 <br /> Address........... 114nn.... <br /> Contractor's Name__:__.._ 6 ----------------------------**--------------------------------------------- ...... <br /> ........... i� <br /> ---------------------- -----------I--------------­------­--­­----------_-- Phone................................... <br /> Installation will serve: Residence 'Compartment House 0 Commercial El Trailer Court [] Motel [I Other C] <br /> Number of living units: ___ It f <br /> --- Number of bedrooms Number of baths __9.eLot size -71?-XI-2 <br /> -_* ........0................................ <br /> Water Supply: Public System ffCommunity system El" Private 0 Depth To Water Table AM ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F <br /> ] Sandy Loam 0 Clay Loam [:] Clay El Adobe El"'Hardpan 0 <br /> Previous Application Made: (If yes,date __.----------------) No e -New Construction: Yes 03"'No [:] FHA/VA: Yes E:1 No Er-l" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wQ ----__Material... <br /> No. of compartments-----W— 't <br /> --------Distance from foundation---- <br /> -----------------Size----- <br /> dePth.----- <br /> Disposal Field: Distance from nearest well__!.-�� - -----------_Ca pacity-A.--_-4,_ <br /> Distance from foundation.-7-6t----------_-Distance to nearest lot line-c5..___..... <br /> ......... <br /> Number of lines-- ------------------------Length,ofleach -------_--------.Width of trench :Z <br /> -- 4_1 .?�4- . <br /> Type,ofTffier material'-R�-C-t-------6epth 6�f­fiflfer m� aterial_/--8..............Total length------;147 <br /> Seepage Pit: I - I ............................... <br /> Distance to nearest well_---777!:77!--------Dista-nce from foundation-10-------------Distance to nearest lot line--(S <br /> 'Number of pits.___.12-------------Lining mafaial.' <br /> -Size: Diameter------ Depth------4&7�t_. ...... <br /> Cesspool: Distance from nearest well--------------- k a <br /> _.Disfane6from found tion--------------------Lining material-___.--___-_-__-_.._.__...____. <br /> Size: Diameter--------------------------------------Depth------ .. -----------------------------------Liquid Capacity -gals. <br /> Privy: Distance from nearest well-------------------------- -----------------��-Disfance from nearest building--------_------------------------------- <br /> k Distance to nearest ]of line <br /> Remodeling and/or repairing (describe):____--_______________________________________ <br /> I---------------------- --------­-----I------_--------1-1----------------------------------------- ------------------------- <br /> --------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------­­-------------------------------------------------------------------------­­----------------------------------------------------- <br /> ---------------- ------------------------1-1----------------- -----------------I------------- ...... ------------- - <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, State laws, and rules and regulations e S Joaquin Local Health District. <br /> e S Joaquin <br /> regulations <br /> (Signed)--------------------------------------------------------------------- - - --- ------------ --------------------------------------------------------------(Owner and/or'Contractorl <br /> 'By:..................... <br /> ------------- -------*- ----- --- -- ----------------------------------------------------(Title) <br /> i -ea n � wells,I system <br /> m n r <br /> (Plot plan. showing size of lot,'-location system in la ion t wells, buildings, etc., can be placed on reverse side). <br /> IFO"EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY______________._- ----------------------------------------------- DATE_. <br /> REVIEWEDBY--------------------__............... DATE-_ ------------------------ <br /> BUILDING PERMIT ISSUED-----__------------------------------------------------------------------------*------------------------ <br /> *e ----------------------------*------------------------------------------------------- --------------------------------------- <br /> Alt ratio$ d9r/or recommendations:------------- --- ___--- <br /> x ------------------------------------------- F---------------------------------------------------------------------------- --- <br /> 1063--------- ----------__ <br /> --- -. ------- <br /> ---- -------------I-------------- ------------------------------------------------------------ --------- <br /> ----------- <br /> ---------------------------------------------------------------------------------------------- ---------- <br /> ------------- .......................I-------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------ <br /> ................................. . ------- ------------------------- - -----------------­--­ ---------------------------- ---------------------------------------------------------------------------I------------ <br /> FINAL INSPECTION BY:.--- Date---------- <br /> ------------------------------- <br /> �/......------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Am erIcan Street <br /> Stockton,California 300 West Oak Slr#@t 124 Sycamore Sfr*ot 205 West 9th Street t <br /> Lodir California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 FM 5-62 ATLAS <br /> F <br />