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y FOR OFFICE USE: <br /> 3 <br /> �L <br /> APPLICATION FOR SANITATION PERMIT Permit No. .........1.�.�: <br /> ----------- ----------------------------------------- (Complete in Duplicate) ?�d��7. <br /> Date issued .•_..--..-.•. ---_-_.- <br />------------------------------------------------=-------- This Permit Expires 1 Year From Date Issued �`�`3''.. <br /> O�s-'0 2- <br /> A pplication is hereby made to the San Joaquin Local Health District for a permit to construct and insta 1 the work herein described. <br /> y This appfication,is,made in compliance with County Ordinance No. 549. 11t}TH KOf <br />-, IS`r3 s <br /> JOB ADDRESS AND LOC TION �� --� - XIX-LEY------- 1�-..I..rt�� _--�&E................ <br /> Owner's Name-----jq.I` jNj------•4-s--F� =------------------------------------------------------------------------------------•- Phone------------------------------------ <br /> Address---•----�-.......PF___RRI.-N....... -------M.19.N--n a. <br /> Contractor's Name----------0.V/_A.F-- ' ' ----------------------J ..... Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial E3/Trailer Court [IMotel [3Other ❑ <br /> k <br /> Number of living units: J.__. Number of bedrooms - :' Number baths ---/--- Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private it Depth to Water Table _J-_-_ ft. l <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ SandylLoam E'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [3 <br /> Previous Applic fion�Mede: .(If yes;date-,--..-___---.-::-)-,No ❑� '-New-Construction: YesT❑ No'[]— FHA/VA: Yes.❑_ No ❑ <br />:;7--; -- - --. , .�- - <br /> LZ <br /> TYPE OF,{INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic nk: Distance from nearest well---��------Distance from foundation...... ...........Ma# rial---CONCFF-'1:F_ <br /> p No. of compartments----- ...--_...Size3 X_3_X-_57 Liquid depth------- ---...---- _._Capacity../P00,664 <br /> Disposal Field: Distance from nearest well.--- .-.._Distance from foundation....147..........Distance to nearest lot line-._-t-_- '. 1j, <br /> Type <br /> � <br /> [P <br /> v� Number of lines--------rL------------ .-. <br /> -------Length of each line_---_-_._-.-----_____-----_-_.Width of trench ��_----__--- <br /> Type of filter material.•- x_4.1 -------Depth of.filter.material------ait!E�.... ..__Total length.......... ........................,,... VV <br /> Seepage Pit: Distance to nearest Well_+ -_-.Distance f b #oundati n---_____.--- Distance to nearest lot line-------:......... <br /> Cess ool: Distance from nearest well - -- -Distance from foutndation`�.... ..... Depth--.----._-._._..___...._._....... <br /> ❑ Number of pits-------- ------------Lining material-_--_-- -. --- -----.Size: Diameter <br /> p ....dining material <br /> ElSize: Diameter.------- I------------------- ------Depth--------------------------------------------------Llqul apacify---- ..-, ....-.. gals. <br /> 11 <br /> Privy: Distance from nearest well--------- -------------- ----------------------Distance from merest#b�ing--__---_ r} <br /> �_. .-- ................. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- -....----....-----...--------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------------------------------------------:--------. ------.---- I_—--------------------------------------------- <br /> --•---•----------•----•-----------•------------=--------•-•------------ •-•--------------- ----•----•--- ............----------•---- -------------------------•--- ---------------------------------------------------- <br /> ---------- <br /> ----------------------------------------------------------------------------------------------------------------------------------...--------I-----------­­-----------7-----....----•---------•----------------------.---- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancASfaaws, and rules and regula+ions of +he San Joaquin Local Health'D'tistrict. <br /> .._ __-_ _ _ ----------- -::------------:-_:.:._ . �:--(Owner and/or-Contractor)19 . ..... t (Title) ------- t <br /> --- ----•-•---•- <br /> (hot plan, showing size of lot, location of system in rela+ion to wells, buildings,,etc., can.be placed on-reverse side).,,, ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ©`---------------------------- ---••--- --------------------------- DATE...... `. .-`-- ------ <br /> - <br /> REVIEWEDBY-------------------•-------- -• --- ------------------------------------------------------------------------- DATE-----= -------•-------- --------••---------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------- <br /> .. --------- ------ <br /> Alterations and/or recommend'ations:gxc_A�IRxfo.4--•------------ ...........I.............................I...........--------•-••--•-................ cAy1.4r G n/ I <br /> ENctH4YQ .......... <br /> '-----­E------OWNjCP---- -----� iT-H----- I rs ►PE--.-�NS7 ] �. <br /> ----------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> .:........................................................................ <br /> ti <br /> FINAL INSPECTI Y:.-- �.._. . Da ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Strut 124 Sycamore Strut 205 Wert 9th Strut <br /> Stockton,California Locil,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 EM 5-6I ATLAS - <br />