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FOR OFFICE USE: _ ~' <br />------------------ -------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....... <br /> . _ Y� <br /> ---------------------­- -------- ------ - ,, v..(Complete.in,Duplicate) <br /> __ �— <br /> _ Froin.Dat Issu �� �7=-Ddtqy <br /> ____ �- - This P eA' lication is hereb made to tie San Joauin-Loctal:HealIA Diste t for'a- 'ermii'tocons ru as ; t-, <br /> II tlis work herein described. <br /> This application Is made in compliance with County Ordinance No 549:- P r -'_ - Oji " ' <br /> Sa, rfield 1- <br /> JOB ADDRESS AND LOCATION-.- .z2. .. ` <br /> :. <br /> Rr:A- iMars. ._Pau Z:°Mar an_ -_'. � -SHO <br /> Owner's Name.... ----•------- = ..... ...--- - , - --= -- Phone:.. . <br /> Address2 ?i...�[,- �1 a; �A7t1.` - S` <br /> Contractors Name...ThB..'174`<Yt^ � -pig_- -; } sei-Y _ �t : Phone__lie�..: 63, 1.... <br /> -a.! a .. <br /> Installation will serve: Residence)WApar+ment-House.❑1 Com1mercial 0 -Trail er.lCourt_❑ Motel �❑�_Other ❑ <br /> Number of living units: _- ,___•Number of bedrooms Number'of ba+hs. Lze __ A <br /> _ of <br /> Water Supply: Public system {�[ _Community system ❑ ;Private ❑ Depth`to Water Table.fl ;ft. 1 ; y , <br /> k I y i E �- f <br /> Character of spill to a depth of 3 feat: - Sand ❑• .Gravel ❑- Sandy Loam ❑, Clay Loam [] Cla-y ❑ Adobe Hardpan ❑ <br /> Previous Application Made: l!f yes,date.S New (ton structiont4Yei, fNo'. FHA%VA _Yes`:❑" No ❑ <br /> , rte � ° • ' � G. 1 i +• <br /> TYPE OF INSTALLATION„AND;SPEClFICATIONS: ' a' z r <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet. .W ► <br /> Distance from earest_welL : Q _ stacefrofoundatio <br /> 1i r -.MteialSeptic Tank: ................ <br /> Ga S <br /> No, of Size .. G"X61-'-. _Liquid;depth <br /> [ X# 1 ' 1 D,s#ar'ii e t nee'rest'to lire_.-•.: .._.._. <br /> g oundation = 1 #� <br /> Disposal Field: iDVumbereofolnes e�.-well 4 Distance. <br /> of reach,lme � --Wid%bfarench. `_2`...:..................... <br /> Type.of filter matenalLfie ? G__ k_-Depth of filter 'material:_ ___19'.-!:�-.Total +len'gth.- .:_::_�.....�Q----­-­--------- <br /> -1 <br /> -,-. -. ----_---- , <br /> Seepage Pit: Distance to nearest`well-.�flO fw distance from foundation 2Q.!: _ e4to near-es+ lot line__.-6-.---_---_ <br /> xx Number of pits-:--.� -Lining materia�OC i r�-- Size: Dlamlet X32=_s' "f Depth Y 2-5t----------------- <br /> Cesspool: Distance from nearest.,t l T r s i <br /> r well Distance from founda+ion i L ning-materlal�_. i -------------- r <br /> ❑ Size: Diameter -1 3 ' Depth " 1 "i-I'�'Li,quid Capactty� _ ._..-_..-_- gals. `-�1 <br /> •--- --------------� y <br /> I-+ �' -' r •� s,-3--'�-� F ..� ...� -t _ <br /> Privy: Distance from ;nearest well s - Distance from nearest, -. <br /> Distance to nearest.lot line - <br /> ; F s 4. <br /> Remodeling and/or repairing . -i-L 4� ' �'� =-------=--------•-• •- <br /> -- -- -------•-...._.... - - <br /> . .. <br /> - -------- - <br /> L44 <br /> ------------------------------------------------------ --------------_---------------------------....... ---- ---- --- . - -- ---------------------------- <br /> 1 f <br /> .-..-..---•••--....---- . - - - - -r : .. �..-: . i.-- F -4 -; ---- ...........:.�.t.- <br /> I hereby certify that I have prepared this 'application and that the'work`will be-done to a Uordance'with"San".loaquin County <br /> ordinances, State laws, and rules and regulations of the;San Joaquin local Health District: ' <br /> (Signed)-----The---DAY & NIGHT _Sept:ic_ Tank 'Se:rviCe z k i-?�..... XUWContrector) <br /> Y• ----- ----------- - :-.. -3 i r -µ T 4 ---i-------- <br /> (Plot plan, showing size of lot,'locatior of'system;in relation to wells, buildings, etc., can be placed ori reverWstde) <br /> .FOR DEPARTMENT USE ONLY <br /> _.. -'. --.--.-- 4 ' <br /> APPLICATION ACCEPTED BY {-1 (DATE =-=: .: G <br /> REVIEWED BY- I I' s----------------------------------------- = ,DT., �'- <br /> --------------`.___ I .. .A -ATE i h i <br /> $U}LDING PERMIT ISSUED..........:. ... =r i t # --•------- <br /> - - --------- A E_ - i <br /> Alterations and/ r recommendations:- --------------------i-- -- -. -1�-t-� . � ' - --------------------------` ' T --"--."":"� ---... <br /> •-•_ - Y ­- <br /> / -''•l-,-r- -,• <br /> -•-•----' 7"J-- /--� •--�--------Y--`c�rf ✓- / X �---i - -- -�,-�, <br /> i- <br /> ------ <br /> : I <br /> - - ' --...-t i . <br /> r f ! F+ t ` f I__ r 1 r t��'' t rt-1-1- .L } <br /> ------- f <br /> :. <br /> FINAL INSPECTION BY:---- - - -- Date •-- ----- ------ <br /> SAN`JOAQLIIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-99 L-M 0-61 ATLAS <br />