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FOROFFICE USE: _ <br />--------------------------------------------------------- .' <br /> ____________________.__.______.____.__- --____ APPLICATION'FOR SANITATION PERMIT Permit No. ..,1 __ rl <br />--------------------------------------------------------- (Complete in Duplicate) 3 <br /> Date issued .__ <br />- <br /> ------------------------------ --------------------- This Permit Expires 1 Year From Date Issued <br /> �---- <br /> Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 --�-- MANT-1-cfl . <br /> JOB ADDRESS AND LOCATION?1DE ..== 1. 7i. .._ �1C. [v .. <br /> ------Be-N.�t>�.r._To------ r <br /> Owner's Name-----•-- "` - -t-�-�-��-S-Q�-------------------------- Phone.------------------------------•--.. <br /> Address..............Rr, - 5.:_.=--....0.0.k._.--..227 /_ X!I-r��ci) .......---..............................._.------------- <br /> Contractor s Name-------------- I . � � ! . ............... Phone - <br /> - -•------------•-------------------- <br /> Installation will serve: Residence Z'_ApartmentjH6use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ' -. <br /> Number of living units: _-_�._-_ Number of bedrooms � Number of baths ..1.__ Lot size _-/j0Q--__y..-.,,AQ2-�_�.•_--_____-_ <br /> Water Supply: Public system ❑ Community system El Private �epth To Water Table <br /> Character of soil to a depth of 3 feet: Sand EKGravei❑ Sandy Loam e Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) NoNew Construction: Yes 1?/No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:.,, <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet_,) <br /> ` C0/VC <br /> Septic k: Distance from nearest well__•��.___._Distance from foundation___��____.____.Mater-al__ _ �i�T-�-____�. <br /> No. of compartments. --_____ ...___Size_ X Liquid p I--11 _.____Capaaty.... _:. _ <br /> -- ----- � __ _.Li uid de th-...- • II -p...... <br /> Disposal Field: Distance from nearest well_________________Distance from foundation......•-,r.... Distance to nearest lot line................. <br /> Number of lines------------)_ Length of each line_.____.1��Q_' ___F.Width of trench-_ --_•__- ��_ <br /> Type of filter material__/3_C_C-K__Dept-I,. of�filter material______' _�f_____Tota! length________:_ � � _ <br /> ❑Seepage it: Distance to nearest we ---------------- <br /> - _ -- from _ anon- _ Dis <br /> __---xfance to nearest lot line................. <br /> Number of pIts_________________---•Liningma#iniac---------.------- Size: Dibmefer.......... .........Depth................................. <br /> Cesspool: Distance from nearest well................Distance from foundation___________________.Lining material_._____-.--.__-.____________.____._-_ <br /> ❑ Size:1DDiiameter.-----------•------------------------ DlePth----------:_;--'--------------------------------Liquij Capacity-------------------------._.gals. <br /> Privy: Distance from nearest well----------------- �,_+y�_--_:_Distance fro�ttr+ nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line---------------- ----------------- <br /> ------------- --------••-•-•----• --•--------• -------------------------------------------------- <br /> Remodeling�n o i <br /> ad/ r rape+ring (descr be) -------------------------------------------- -----------------•--- <br /> --------------------------------------------- <br /> --- --- --------------------------------- ------------------------------------------. � ---------�D �-------------------- ���-------/ ----- ----F---------------- <br /> - jf <br /> _____________________________________________ _____________________________________„..___._.___r._..._ _ �_ <br /> I hereby certify that 1%ave prepared this application and that the work will be done'in accordance with San Joaquin County,, <br /> ordinances, State laws, and rules and regulations of 66 San Joaquin Local Health District. <br /> t s+ <br /> (Signed) •.-!/t/•,PIY I � 2 -,f= _ _ --------------------------- _-------{Owner and/or Contractor) <br /> By:-----------------------------------------f........-........-.........................•---------- =---------••- Title <br /> (Plot plan, showing size of lot, location of system in'relation to wells, buildings,!etc., can be placed on reverse side). <br /> _.&,- A <br /> r-�� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- l___.t-R,-0-----------------------•--••----••--------•-------••-------------- DATE------� •3-1 ---------------•--- <br /> REVIEWEDBY----------------------------------------------------------------••- ----------------­-----------­----.................. DATE--•----_-•-•----------••---------- <br /> --------------------- <br /> BUILDING PERMIT..ISSUED-------------------I........---•--•-----•-----•------•- ................:................••• DATE----------..------••---------------•------------------------- <br /> Alterationsand/or recommendations---------------------------------------------------------------------------------------------.................................................................. <br /> �- - <br /> •. <br /> FINAL INSPECTION BY: f'mO.. ----- <br /> Date------- ---.:.L__��...T. _ ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca.California Tracy,California <br /> E5 9 REVISED 6-59 2M 5-62 ATLAS <br />