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FOR OFFICE USE: ' <br /> ----------------------------- ------------- ------'.------ <br /> ------------------------ --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..../... Ll._, � <br /> ------------ -------------------------------------------- (Complete in Duplicate) / <br /> ---------------- This Permit Ex fres 1 Year From Date Issued Date Issued .� Z 2-_...1� <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the wok here described. <br /> This application is made in compliance with County Ordinance No. 549. C <br /> JOB ADDRESS AND CATION__ - : �—• <br /> i VN___:- • _ - + at `- Soy+ <br /> R -0A_5 .I_I) ----- <br /> Owner's Name------ ! Phone-------............... <br /> Address--------•--- .x....13 _. ------ <br /> Contractor's <br /> ---Contractor's Name.....Ah.* sap.7a�---�5R1/j-�- ............................ Phone------- .......................... <br /> Installation will serve: Residence �Apatrtment House ❑ Commercial E] Trailer Court El Motel ❑ Other 13Number of living units: - _. Numb r;of bedrooms _�_ `-- <br /> __;Z.—Number o baths ____ Lot size --_ R� �...................... <br /> Water Supply: Public system ❑ Community system C] Private epth To Water Table 5-- ft. <br /> Character of soil to a depth of 3 feet: Sand&-OGravei ❑ San y Loam Clay Loa ;VNo <br /> lay ❑ Adobe E] Hardpan E]Previous Application Made: (If yes date_______________ ____) No eNew Construction: Yes ❑ FHA/VA:,Yes ❑ No <br /> TYPE OF INSTALLATION AND'SPECIFICATIONS: — W=— <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i M <br /> Septic Tank: Distance from nearest weiI_______.>_---__._Distance fro; undation___________________Material-------_.___�___._�.------------------------ <br /> S p1 K� No. of compartments-----— - ,.,Size, Liquid depth------ ------- ----------Capacity----,•'.. <br /> Disposal Field: Distance from nearest w0 Distance from foundation----/_____.......Distance to nearest lot Iine.�E._..___---.- <br /> (� ' 2 ? r I <br /> -ii tN�+ Number of lines__________ Length of'each line;.-__507___-_��__..Width of trench______ ____ ___ <br /> �D� 7yperof`filter"rrla`t ri I"'.RD /5,--Depth of filter material_.._.- ------•--Total length------------------------�---...... <br /> ) i I i <br /> Seepage Pit: Distance to nearest well_____.__..___._______Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pitsa _'4��_____Lining material.____ --- -------- Diameter----------------------- <br /> 1 � � Depth----�--------------------------• <br /> Cesspool: Distance flor>tirieares4�well---------------- Distance rom foundation_.-________._____..Lining material__.____._:_ _____________.._...._. <br /> ( � _______.Liquid Capacity I ---------------gals. <br /> ❑ Size: Diameter----------------- - ----------------De th---•--•'------------�--�--------------- <br /> Privy: Distance from nearest well-__-_._.__.___!_______________I'l?!__--_ l isfance from nearest building ------ ---------. <br /> } ) 7rd ----. --•----•-----r-------•------------------- <br /> ❑ Distance to..:nearest,.lolmer. •� r===== <br /> Remodeling and/or repairing (describe):------------------- ----_--------___-. - <br /> -------------•-------------..._..---------•----•-------------••--"...------- <br /> , <br /> IA--•--------------------------------••--••--•------•------------••-------.-_-_-.--------------------------------------•- <br /> -------•----•------------------------------------------------ • I I. �3 I <br /> t <br /> I hereby cery'4 that I have prepared this application and that the work will be done in accordance with SanI aquin County <br /> ordinances, St4lreAaws, Wind ru es a e ati ns of the San Joaquin Local Health7District. �4liM <br /> - --- -------------- --- - � ___._._.-_--_..._ ----- ________._-_...____-.____________________-_-.-_____._. -___�( <br /> ' / f <br /> (Signed)__. �C Owner and/or Contractor] <br /> By:----------------------------------------------- - ------------ - --- ----------------------------------------••----- ----)Title)-----r- <br /> (Plot plan;showing size of lot, locaton of system in'relation to wellt,"buildings;etc:"can`be,'placed'onfr•eversa side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- - ..---------------------------------------------------------------- DATE-------7747 <br /> L- ------ <br /> REVIEWED BY__.. - ----.. DATE-------_----------•--•--•- •-- .. <br /> BUILDING PERMIT ISSUED -------------------------------------------•-—------------------------------.--- _. DATE--------------------------------- <br /> Alterations and/or recommendations----------•-•-�•-----------------------------------------•---•-•-•---------------------•---------....----------------------------- <br /> __1---------------------------------------------------------------------------------------------- ---------- ----------------•------------------------- .- - <br /> ----•--•-•---------•-----------------•-------------•---------- ; <br /> -- -------------------------------------------------------------------------------------- --- <br /> ----- i <br /> t <br /> FINAL INSPEC BY:_ - Date------ 4- / .: - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />