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v� m,vrrit-i:mzlt <br /> -------------- <br /> --------- ------ <br /> ----------------------- ------------------/------------- ;APPLICATION'APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------I------------------------------------------ /S.-k..? <br /> (Complete in' -Duplicate). <br />------------------------ ---------- -------- This Permit Expires I Yeai From Date Issued'- Date Issued <br /> Application is hereby made to the San Joaquin Local HAM Distri <br /> e in compliance with County Ordin'ance No.c549. 1 <br /> This application is mad t for a per}it to construct and install the work herein described. <br /> JOB ADDRESS AND LOCATION.... 142o Micliael <br /> ---------------------------------------------------------------------------------------------------------------------------------...............I------- <br /> Owner's Name------------T e.d---a <br /> 0 <br /> Address............. —------------------------------------- ---- Phone-----Eq....4na7g.. <br /> ZQj4 I--------•----------- <br /> --------*-------------------------- <br /> --------------_---------I-------------­----- <br /> ----------•.......­-----------­----------_-----------------........................................ <br /> Contractor's Name------------------- Inc. I <br /> --- - --------------------------------------------------------------------- Phone.....4qit 5�!!59 <br /> Installation will serve: Residence Rl': Apartment House f C] 'a Trailer 6OU114 b), W/t�e_ <br /> Commercial _e_r 0 <br /> Number of living units: I.... Number mber of bedroom' Number of baths Lot size .......1D_()...X1Z0.0 <br /> Water Supply: Public* I . <br /> system K) Community system E] P' y <br /> Character of soil to a Private [_-] Depth to Water Table 3,5--- ft. <br /> depth of 3 feet:. SanJ E] Grav�l L] Sandy Loam E] Clay Loam F] 'Clay 0 <br /> 1, 1 Adobe M Hardpan 0 <br /> Previous Application Made: {If yes,date--.----------:--------) Nog] New Consfr I <br /> 11 7 uction., Yes EM No [-] FHA/VA-.. Yet [-] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - I <br /> (No septic tank,'or' cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-_. <br /> ging No. ------------Distance from foundation............-------Material,................................................ <br /> of compartments------------------- ------Size---------------------..------ Liquid depth------------ -------------Ca pacity--------------- <br /> Disposal Field: .Distance <br /> Distance from nearest well-_--- ......Disfasnce from foundation-------2_4r-------Distance to nearest lot line....... <br /> Number of lines-----------------/--------------�Lengfh of each -------------Width of trench..--_-••---- <br /> + O-PP CR Type of filter maferiaI-­-4-.,_,eZ------!Depth of filter matehal-------Z�'f--.--Total length.--.-..---.1_.%'._-_•----------- <br /> jj <br /> Seepage Pit' Distance fo nearest well _ <br /> KI Nu'rriber of pits-_ .1 -----Disfance-from-founAtion::-.._1A_____--.Distance to nearest lot line.....5-1-------- <br /> Cesspool: -----------------Lining maferial._X�QQX--------Size: Diameter----33.._......... -------- <br /> .......... . (`�, <br /> is.;ahee;.fi:om nearest well . "I ion--,-----------------Lining material_.----.It's 61stance from foundaf- 1 i <br /> r V I le <br /> Size: Diameter---------A-----------------------------Depth-------- - Liquid Capacity - ----------*------------------- <br /> -------------*------------------------ -----------------------_--gals. <br /> Privy: <br /> Distance4rom neares�t'-Well <br /> Ej f ---- ---------A_-�--------Distance from nearest building............... <br /> A Distance to nearest lot 6e�---f� I * ! .�1' - il f ---------_---------------- <br /> ---- ---------------- <br /> ------------­-­­-------------------------•---------------•---------- <br /> Remodeling4 W <br /> or repairing (descri[66):------9441,49 -311 <br /> ----------------------------------iI---------I--- ------- <br /> -----------------------------------------_-----_--­-----7---------- <br /> ­ L <br /> ----F---i---l-----t----e--- <br /> -I- <br /> r-----------B-----.--e.---.--.d-------.--.---t-------------.--.---e-----x-------j------8-------t-------j--L--p------g--------- <br /> ---.---.---.--p-------y---------p---------l------e----m <br /> ---­--------- -. _ ------------- <br /> - --- - <br /> - - --------- <br /> --- <br /> --------"----I <br /> hereby certify ----- <br /> - <br /> - <br /> - <br /> that I have prepar;d-Ais applicatic'n"and-thwt-th-a-wrurk—wiii-We done in accordance with San Joaquin County <br /> ordininces; State laws, an-d.rules_ae 8T49ulafions of the San Joaquin Local Health District. <br /> d) ......inq---- <br /> -----------------------------------------------------------------(Owner and/or.Confractor) <br /> Signs' A_59P <br /> By:.......... .........P_q%!X!y___0,.—Whan.. <br /> --------------------------------- <br /> (Plot plan, showing siz— ------------_----------------ITitle)---- ......__........ ....------------ <br /> eoflit'location of system-inrelation to wells, buildings, etc., can be placed on reverse side). <br /> N. <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION-ACCEPTED <br /> CCEPTED BY---_ <br /> ------- ---- ---L__ _ <br /> --—---------------------------------- DATE. <br /> -------------- <br /> ---------- <br /> REVIEWED BY--- ------------------• --------- ­ DATE------- - <br /> .... ........ ---------------------- ------ -BUILDING PERMIT ISSUED.. ... --------------- D------------------------------------------------------ ATE-----------------Alterafio and/ recommendations:-----_..-_---- <br /> -'•--'-•-----"--•----'--'---•--•----•---• <br /> ------------- --I-------A---------------- <br /> ------------------------------------------------------*-----------**------------- -- ------- ------------------------------------------ <br /> ----------- <br /> ..........I---------------------------------------------- -------------- : el_� - -------------------------—.......................... <br /> - -----------­----------------------------------------I----------------------------I..........­­­,........I.................I-------------------- <br /> -----------1------- ..............................................:----------------------------------------------------------------------- ------------------------------------------------------------------------------ <br /> ...................................... .............................. ------- ---------------- <br /> -------- --------------- ------------------------------------------------------------------------------- ........ <br /> FINAL INSPECTION BY:..-- .. .----- ------ -- - --------------------- Date..--.. ..... ... Z_ <br /> . <br /> ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Woof Oak Street 124 Sycamore Street 205 Wes+9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,C'olifornla <br /> 9 REVISED 8-89 2M 5-61 ATLAS <br />