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rc}K Urr� �5t <br /> ----- l/ <br /> ___.- _ .._7_ ------ __ APPLICATION FOR SANITATION PERMIT Permit No. _ 7 _•_�3�J <br /> q/ <br /> - -4 �-------- - --------- ----------- (Complete in Duplicate) Date Issued -� <br /> ---- -- - q- -_ - - -'' -- 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. 07 9'v <br /> JOB ADDRESS AND L�O"CATION ` .. 11: I� l'� iF . .-•------•-----•------•-............................... <br /> -•--•----•-•----.-- <br /> Owner's Name. � Wim..--la4 Phone <br /> Address-----------SA.&iiia............... <br /> • • ------------------ •............................................................. <br /> Contractor's Name.............. �+ f/f--------•-------_----• - ---•-•-------••...................... Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -e,9 <br /> Number of living units: _ ___ Number of bedrooms l--- Number of baths .,-?._- Lot size 14&o— '. ........... <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table jg�F.`ft. <br /> Character of soil to a depth of 3 feet: Sand [j Gravel ❑ Sandy Loam'El Clay Loam ElClay ❑ Adobe Hardpan C] 5 <br /> Previous Application Made: (if yes,date____________________) No 2`_New Construction: Yes Ug, No ❑ FHA/VA-. Yes ®-� No ❑ t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Spptic Tank: Distance from nearest well___`&___Distant fpm <br /> ize. ....f�f.-ou1nfda�.t.iLoinq..u..id...........Mat jal..&c.�r... <br /> depth-.- Cit ..�Q1 <br /> ..---- <br /> No. of compartments----- --------- S <br /> f s <br /> Disposal Field: Distance from nearest well._, ��_.._Distance from foundation_._.1�Al tante to nearest lot line.......... <br /> Number of lines--------2-_____,x.________ _Length of each line-----A _ __' _ ------- <br /> Number idth of trench...Z._ <br /> �}�i ` ---------------- <br /> Type of filter material.— _ - _-_Depth of filter material-___!_-__-------Total length___ �......................... "I�►, <br /> or---- 1 /..__..Dis ce tp nearest lot line._trj'_-__.__ <br /> Seepage Pit: Distance to nearest well---- Distance ftpm foundation... <br /> [i Number of pits_________________Lining material__/1rI9.C_��__....Size: Diameter__ _ .... _________________ <br /> Cesspool: Distance from nearest well_________________Distance from foundation---.-.--------------Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------:----------------------------Liquid Capacity................_...........gals. <br /> Privy: Distance from nearest well_________________________________________________Distance from nearest building------------------------------------------ <br /> Cl _ <br /> Distance to nearest.lot line._--:=------•--• -•---------- --------------------...- ------- <br /> •--•---- <br /> -------------------------..--•-----•-----•-----•------------•-•------.. <br /> Remodeling and/or repairing (describe):.------- -------------------------•--•- -----------------•--------------------------- <br /> --------------------------------------------------------------------------------------------.................­....... -----------------------------------------------%--­-------------------­­---------- <br /> ..................I--­----------------- -------------------------- ------------------------------------------------------------------------------­-----------------I—----------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------------•----•-------- <br /> I 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 the-San Joaquin Local Health.District. <br /> ----------------------- -------------------------:-- ........ - <br /> Contractor](Signed). . . <br /> By:---•---- <br /> ....... •••---•--•---•---------------------------`---: - --------------------_trile)--- ----------------------------------- <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____- <br /> .� f <br /> / A � -------------------- <br /> REVIEWEDBY-----------------------------------• f-------------------------- •------- -----------------•---------•-...... DATE.----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---- -- ,-----------------------------------------------_.................. .........---------- DATE--------------------------------------- <br /> ... <br /> i Alterations nd/or recommen ations:--,l-��.���------� z <br /> --lz= -.----• ---�r ��---- <br /> �. - � -- f� ------------ -------------- <br /> X61-- <br /> --------------------------------------------------------------------------- --------- ------------------------------------------------------ -------- ----------------------------------------------------------------------- <br /> -------------Y-----------------------...-----------------------._..---.- ---------------------------------------------------------------------------------------------------------------------------_..................... <br /> r r <br /> FINAL INSPECTION BY:,-------- - - — ------ Date----------- ........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street w 205 west 9th Street <br /> Stockton,California - ti Lod],California Manteca,California. Tracy,California <br /> ES 9 REVISED 8-59 2M 8-61 ATLAS <br />