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FOR OFFICE US : <br />--.-_-✓---f_.--l0. - :--------3 -3,3 APPLICATION FOR SANITATION PERMIT Permit No. <br />------------ ----- --- -------------------------- (Complete in Duplicate) Date Issued .___. ._,13/�.� <br /> �P <br />--------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 11 E' <br /> JOB ADDRESS AN LOCATION_.�..�---------- <br /> --------------- --------------------------------- <br /> •• <br /> Ow e` t Name..,ZjilAon—a � d�!?iLV-. ------- Phone-----------------------------....... <br /> Address---------------•�..... ... .. <br /> ................ ..-«ext,:----- p.4:�1���1..----- -•-----------•----------•......................------------•- .....-----•-•-----•--•-•--...-----._......---- <br /> Contrac+or's Name. -�--------------------------------------------------------------------------------- Phone <br /> i <br /> Installation will serve: Residence [lam Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> v <br /> Number of living units: _I---- Number of bedrooms _An- Number of baths -_/---- Lot size _A_.7°_7...�...J�------------------------ <br /> Water Supply: Public system Go- Community system ❑ Private ❑ Depth ro Water Table 1.12. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8—Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No EB" New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No [�F­ <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 well___--" --..Distance from foundation---/P--..----_..Material..-� �..../................ <br /> [ No. of compartments...._-I-----------------Size-_.-_ Liquid depth-- �-------------•-•�--Capacity---� QO k-09,4-4-4 <br /> Dispo a geld: Distance from nearest well------ -------Distance from foundD_.ation.� .r----.---.Distance to nearest lot line... 1 <br /> V <br /> Number of lines-------I--------------------------Length of each line------99'--_------_-----.Width of trench._p. vZf.`_..._ .:0_--.--- <br /> Type of filter material.'77-b_K_4--------Depth of filter material____A..............Totallength.---....G.d..`..................... <br /> Seepag Pit: Distance to nearest well_- ---------Distance from foundation-•��c•r._•.-.--..Distance to nearest lot line__------.r...... <br /> Number of pits------J-------------Lining material._:---.11ls4ft----Size: Diamete r_._.2A-............Depth_--z4 -------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------------....................... <br /> ❑ Size: Diameter--------------------------------------Depth-------------------.--------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------------------------- from nearest building-- --------------------------------------- <br /> Cl --- <br /> tDistance to nearest lot line---------------------------------------------------------------•---------------------...-------- ----•---...------.........-.....-------- s <br /> Remodeling and/or repairing (describe):-------------- ----------------------------------- -----•---------------------•-----------------......----------•---......__. ................... <br /> .......--•---------------------- -----------------------------------------------------------...-----------------------------------------------------•-------•-----------------------------••---------------- ------------- <br /> -..-.-...--••---•--...----------••--------•--------------- -•----------------•---------------------------------------------------------•-------------.-...---------------...--•------....------------------------------ <br /> •-----------------------•------•-----....--------------------_---_------ ....- ------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> 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 of t e Sa Jaaqu' Local Health District. <br /> (Signed)---------------------------------------------------------------------f - (Owner and/or Contractor) <br /> B (Title)_ <br /> (Plot plan, showing size of lot, lacatiA�s+�e to elation t. ,wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- -------- ---------------------------------------- DATE...._- <br /> --------------------- <br /> REVIEWEDBY-------------------------------------- -------------- -------- -------------- DATE------------------•---------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------- _–-------------------------------------- DATE-----_------•-----?..1------------ --------....---•- <br /> Alterations and/or recommend'ations:--.---- -GSC.-. - c.n-c- cam..., -r� .i2_� -.. - _ .,--------- <br /> --------------- <br /> -..------------------- -------��--�7-�=_---------------------- <br /> ------------------------------------------------------------------------------------------------- --- <br /> - <br /> Dafie <br /> FINAL INSPECTION BY:..-- .....-... zi —----------------- /7._.-..... - <br /> 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamero Street 205 Wort 9th Street <br /> Stockton,California Lodi,Callfwnlo Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 2M 5-62 ATLAS <br />