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'OFFLCE UZE: ' <br /> f (GJ <br /> APPLICATION FOR- SANITATION PERMIT Permit No. <br /> (Comple4 jn Duplicate) ] Z <br /> "-- --*' This 'Permifi'Ex ires'1TYear Frorn'Date`Issued <br /> Date.Issued,-, ,/--.i_......��&3 <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 iin compliance'with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION S---------------�5........I.....:---­-----------r-TD .-------------------------------•----------------------------------- <br /> Owner's Name---- ���<.........A --------- <br /> Address <br /> Add ress------------------- C�• gg <br /> -----.---••-------•----------F•--------•F-----•--------------- ----------------------------•----.--- ____---- <br /> r <br /> Contractor's Name--- -= ---- '_ ' ', /� �� � /�7�------ ----4 /l� _..-----/1 e------------------------ Phone / ---�___�f©�---- 4 <br /> t <br /> Installation will serve::- Residence 'Apartment House ❑ Gomme�cial •❑ Trailer Court [j Motel ❑-"""Other-❑ _­ <br /> Number of living units: __�___4Num6er of bedrooms ��.Number of baths ___� Lot size --h'Q.._--._-�(___ ___________________ <br /> Water Supply: Public system e Community system ❑ Private`❑� Depth to Water Table 4,$rft. ` <br /> 5 <br /> Character of soil to a depth of 3 feet:t Sand E] Gravel E] Sand y Loam E] Clay Loam ®'Clay E] Adobe �Hardpan�❑ 4; <br /> Previous Application Made: (if yes,ddte--------------------) No New Construction; Yes E] Nom FHA/VA: Yes ❑ e. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 5eptic•Tank-: n Distance from nearest well_____ _ _ <br /> __________ _Distance from foundation__..__________.____ .Material___�_ .._.____- _____.___.______.__..,----__-. <br /> Na�s�ev tic tan or cesspool ermltted if utic sewer is'evadable within 200 feet. . . <br /> :❑ E'Y�' No. of compartments------- ------------ ----Size----------------------r Liquid depth------------- -- ---------Capacity--••------------------- <br /> a3 Fie d: Distance from nearest weh AJO../ e Distance from foundation______- _.Distance to nearest lot line-___-S__._ ____" , <br /> 11-1 <br /> . <br /> pis® . Number of lines__ _ -� _ ----------Length .of each line_ _____ Width of trench.-. _- --_-1--Y. __---______ <br /> Type.of.filter material__ECOJe------Depth of filter material. }_jg-.-k--__Total length------------------------- <br /> 4 i <br /> Seepag�J'. <br /> Ditance to nearest wellpN __Distance from foundation __ 0_--------Distance to nearest lot line ._______ <br /> to " Depth - t <br /> Number of pits__.:_' ,l__------ Lining material__-_�7-D�__-Size: Diameter s��_...___ _______________ _._. <br /> Cess ool: Distance from nearest well--------------- <br /> __'Distance from foundation.:_. _-_._'.___.Lining material____..________________________._____ <br /> p <br /> ❑ Size: Diameter---°,-{_s---- i.Repth----------- --- ---------------- -----------------Liquid Capacity----------------------------gal <br /> s. <br /> E <br /> ❑ Distance to nearesrest well___:_______....'______________________________Distance from nearest building-_____.___________________.__________.__. <br /> Privy: a-. , tt � . <br /> Priv Distance from nearest <br /> lotline--- ---- ---------------- ------------------------------------------- ------•---------------------------------------- ----------- <br /> 1pairin'g <br /> Remodelin and or describe :____--_- _g / � } ��ll�------TQ------�X!�.�-jam'✓-��----------`-5-��-'�- Ems---------------------------------------- <br /> ---------------------- <br /> -------- -----------------------------• <br /> 5 3 1 t - <br /> ------------------------------------------------ <br /> t <br /> i t �I I t1 d.. . ''r <br /> ---------------------------------------------------------'------=---------•--------------------------•-------------------- --------•------------------ <br /> I -. Tt <br /> -------------------------------------___----------------_------ F___________-________________-_#__________.-------------------------------—--------------------------------------------------------------------------------- <br /> y <br /> I hereby certify fhat•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.E <br /> U4 <br /> PGit�c `, Owner and/or Contractor <br /> (Signed) 'G ---- ------------( / ) <br /> BYf --------------------------------- ---------------(Titer------ � - _ ------ tr <br /> (Plot pian, showing six eof.lot, location}o system in relation to wells, buildings, etc., can be placed on reverse.side). <br /> OR DEPARTMENT,USE.ONLY <br /> APPLICATION ACCEPTED BY- - = DATE = �� - -------------- <br /> REVIEWEDBY --- ------------ {----- ------------------------------------------------------------------------------- DATE--------------- -----..------------ <br /> BUILDING PERMIT ISSUED._.._.......----=-----------------------------------==-----•---------=-----------------------------. DATE---------------------------- ----------------- =------ ` <br /> Alterationsand/or recommendatia : ------------------ ------------------------------------------------------------------------------------------------------------------ ---•------ <br /> -------------- ------X/Z. _ --------------------------0 1/1- - ---- <br /> ------- ---- ---------- ------ ------ ------- ------------------------ ---------- <br /> -� <br /> i <br /> - --------------------- -------------'-------=--------------------------------------------------------------------------------------------------- ------------ ------ - - -------------------- --- <br /> a <br /> FINAL""INSPECTION °BY-------2 !' '° Y --------'-- Date"-�.--7--44'� 74:;;`3=--,• - ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street F <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-•63 F.P.CC. .! <br />