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f --••--------•----------------------- ------------------- <br /> ------------------------------------ <br /> ' APPLICATION FOR SANITATION PERMIT Permit No. ...................... <br /> -------------- ------------------------------------------ (Complete in Duplicatei j <br /> ----------- - --- -- --- ( This Permit Expires 1 Year From Date Issued <br /> ! <br /> Dots Issued -_---- •--- -.._-- <br /> 2 7 <br /> Application is hereby made to the SaniEJoaquin Local Health District for a permit to construct and install the'work� m�scrbed.Q <br /> This application Is made in compliance :with County Ordinance No. 549. R I- P. <br /> JOB ADQRESS ANQ LOCATION.JN_....1f-u^� L�� ----R ------ 1.?__ yI`_._Y------Q.f ---- �D <br /> Owner's Name----•--Emmy..-----F :--i &9,gRm <br /> ------ ---------------------­--­-- Phone......................... <br /> Address...... 1------- [LYDA)P&xi R. _rso----- �u1- <br /> Contractor's Name-----814/&E�K.j_ <br /> -------------- Phone........ <br /> = <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer Court ❑ Motel 0Other MMgA <br /> Number of living units: .----- Num ber of bedrooms _1—Number o baths 17 1---k Lot size __. xp 170..---•---•-•---•------ <br /> Water Supply: Public system C] Community system ❑ Private DepWater Table `a.7t.® <br /> r <br /> t Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loathm Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date_________-___ ___I No New Construction: Yes � E] FHA A: Yes No <br /> ❑ Lf <br /> --.TYPE OF INSTALLATION.AND,SPECIFICATIONS' <br /> - �: - -- .F --mow-z :_ <br /> (No septic tank or cesspool permitted if publi7_ 7 <br /> er is available within 200 feet.) <br /> �._ <br /> Septic ank: Distance from nearest well::� .ista a fn foundation-.._. __ <br /> No. of compartments____---�� ize _ <br /> 1 Mat ial <br /> P - --. -x. ----`��-------Liquid depth------ -�-=-- -- =Ca aci <br /> Dis osal Field: Distance from nearest wet-_- --._Distance fromfundation.. . "!� <br /> _..__.....Distance to nearest lot line._. `� <br /> .-.... <br /> Number of lines--I..- <br /> of eacg-',lIie__....�5j _ P Width of trench------ __ ----- - <br /> Type of filter mate tial-- �_-- -- � vial.-_- ----------Total lengfih._ ..------------- --i.._... N <br /> I � ....__De th. of filter mate <br /> Seepage Pit: Distance to nearest well_____________________Distance from foundation____.....______.___.Distance to nearest lot line.....__________.. <br /> 4 ❑ Number of pits---- --------------Lining mater ial-----------------------Size Diameter---•------I•-------DePA------------••------..---•- ( ._. <br /> Cesspool: Distance from nearest well-----------------Distance f om foundation---k----------------Lining material------------------------------------- <br /> Size: 17iameter.----y ---------------- <br /> ---- -----.._Depth---------- -----------------------------------------. Li uid Ca aci' <br /> Priv I � �. � .�. i <br /> Y' Distance from nearest well--- from�.nearest building-- •, s <br /> ❑ Distance to nearefi lot line--------------------- -- -- <br /> --------- ----- <br /> -- -• -----------------------------._.._ 1 -- <br /> Remodeling and/or repairing (describle):------------------------------" t--- --_- <br /> --------- = ------- --- <br /> -.-..-------•- --- ----- ---------- - <br /> -77--- •------ �; � I o <br /> -----------------------------•-------------------------•----------------•-------------- <br /> hereby certify that I have prepared this application and that the work will be done-in-acdordance wi+h San Joaquin County <br /> ordinances, State laws, and rules and a ations of the San Joaquin Local Health District. <br /> ID <br /> (Signed)- <br /> - : <br /> - - ----- --- -- - --- -------------------------------------------------- <br /> --------- __ ___ __(Owner and/or Contractor) <br /> , ,. <br /> -... ---� -- <br /> ------------------ <br /> T ----------------Title --�""""" -.-.�---.�"�._._�_.-____=__.�__ .l ; <br /> (Plot plan, showing sie of lot, location 9f system in relation to wells, buildings, etc., can be placed on reverse side-- i <br /> FOR DEPARTMENT USE ONLY <br /> - 13". �i k <br /> APPLICATION ACCEPTED BY. J .--Ct--------------------------- --------------------"---------------- DAT <br /> REVIEWED BY ----- _:,_ ___-.._ _ .. DATER.......... .....�:.. <br /> - - <br /> UILDING PERMIT;ISSUED------------------1 r <br /> ••---_...D <br /> ATE. <br /> Alterations and/or recommendations: .19R f 14 +1�tv ___::.. --• ...... --------- <br /> ._. ---------- <br /> --------------------------------------------- <br /> ----- fir+. <br /> { •--��---•------sZ- !��7F"4�=-- ,IIl,1: ... = <br /> ..------ -•---------------------- t <br /> • =---- <br /> R► s <br /> .........................................�....•�"!`F. - -+�� � <br /> - e _--______.._____---____-_..___..._.._.._._..._..___--_.__ _ ______.____.__.___.--- --Ae m Date..------•-- ••FINAL fNSP TQM-� .. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> 205 West 4}h Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> E6 9 gEVlS£a e•69 2M 5-61 ATLAS <br />