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FOR OFFICE USE: <br /> ---------------- - ------------------- _ <br />..... ............ ......... ------- APPLICATION FOR SANITATION PERMIT Permit No. _1_ ..1 .. <br />----------------------------------------- --------------- (Complete in Duplicate) Id �— <br /> Date Issued .►.�'..-`�--�-`:- <br />--------------------------------------------------------- This Permit Expires ] Year From Date Issued O•!S--r7o--1,/ <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. / -0 17 <br /> 38 b DD S Ery � � � �/ /•7�-f ,,,�®,u��,T�'-..�`�r���n /��------- <br /> Owner's <br /> ADDRESS LOCATIIOnN_.. - -I_ ..--- /-- ......... .... . <br /> Owner's Name... id11�.L1.t!_. .�L.L'�.1 /�.�-�....�Sr.1..� Phone ---_------•-----•--- h <br /> Address----------------- .i?I. <br /> .71. JyContractor's Name _ �s[ l . 1 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t �` <br /> Number of living units: .-�-_ Number of bedrooms .� Number of sy--J_ Lot size .................. <br /> Water Supply: Public system ❑ Community system ❑ Private 1,CK Depth to Water Table)._Pft. j <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San oam E] Clay Loam [-] Clay C] Adobe ardpan ❑f { <br /> Previous Application Made: {If yes,date--------------------1 No New Construction: Yes ❑ Nq ` -FHA/VA: Yes ❑ No ❑Ih <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pub' se�yer is available within 200 feet.) , �l <br /> S-ptic T Distance from nearest wel�--/-_Distanc E jom f�ju dation•-_-/0------- <br /> 0---__--Materig I_.. `^ <br /> , <br /> No. of compartments-.-Z-----------------Size 1� -fit --__.Liqui depth__-.wd.rj..-----Capacity. <br /> x � 3 �r i t 0 <br /> Disposal F' d: Distance from near t well .---._Distance from foundation-.. �1 ......Distance to nearest lot ine___-9 <br /> Number of lines--- i--___� Length of each line-_--%0_ -- ,----..Width of trench._.. __- <br /> Type of filter materia._.. - _ 4_ _-Depth of filter material__---_?j--_-----_--Total length-------------- --- ---------� <br /> Se Distance to neare fi ,. is ante ram :. ...___. e o nearest lot lin ----�'-_--.- <br /> a <br /> Number _........ ePt ------------------- <br /> Cessp ol:' Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------V <br /> ❑ Size: Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity. •-•-..........•. ----•-.gals. <br /> Privy: Distance from nearest well---------------------------------------- -------Distance from nearest building:___--_.---_---___---____--_--_---------- <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------•------------------•--------.._..- I------------------••------------------- <br /> Remodeling and/or repairing (describe):-__ = h ..................... <br /> ------------------ <br /> --- <br /> 6 <br /> �CL.S --- <br /> -.o-u ..c ------------------- <br /> ------------------------------------------------------------------------­----------------­----------- <br /> --------------------------------------------------------------------------------------------------- <br /> R <br /> _-.--_________-------------------________________________......___------------------------_----------------------------------------------------------------------------------------------------------------. ---------------- <br /> I y hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan cul s and regulations t e Sa J a ocal Heal District. <br /> a <br /> (Signed) ... ....... .... ..-------y-` '-4------ �le---_--------------_---(OunMiliamnlOw Contractor) <br /> _ <br /> Bre----------------•-----=---=-----------•---------------- ----------------------------- --- ------------ .......(rile)---------------_----------•-_ --- --- <br /> (Piot plan, showing size of lot, location of system in relatio o wells, buildings, elf., <br /> t ., ca be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> • ter} v� /� <br /> APPLICATION ACCEPTED BY---------------------------`-- ------- ------------------ - DATE------ <br /> REVIEWEDBY--------------------------------------------•---------)-----------------------------•--•-------....... -----------•-------. DATE -------------------•--....----------•------- <br /> BUILDING PERMIT ISSUED--------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-.---_..__-------- -------------_-.------ -_ <br /> -•-----•--------------------------- <br /> Ar1-7 ------------------------- - ---•-- ' <br /> RNALINSPECTION BY: ------------------ Date---- --- -------------------------..-.._--..-T----------------------------- <br /> SAN <br /> - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Weft Oak Street 134 Sycamore Street 305 Woo 91h Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> 48 9 REVISED 8-59 RM 5-61 ATLAS - <br />