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FOR OFFIC USE. <br /> 6 / 3 G <br /> ........ ... 1. 1. .-�..-�y?/ . APPLICATION-FOR SANITATION PERMIT Permit No. <br /> l (Complete in Duplicate) Date Issued <br /> ................................ ....___..__._._-_ I 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. (oS ZED d ' <br /> [ �`t <br /> JOB ADDRESS AND LOCATION_....'W_ 4.f EY_...-AO fJ.vh!--------- -------•-�-- Ut_.........Y!/YA /-1---- <br /> Owner's Name........V7. _;r%f ir- ........ _<_..�y------------- -----------------------------------•---- -- Phone.---------------------------- <br /> Address................. -,459 k_4,.CE. ..-•---....�Cl:/V�L.N..........................................----....... <br /> -L w�t=-'y---.... ' <br /> Contractor's Name ......./ ! e................ Phone.../z 6r/f�07.. r r <br /> r <br /> Installation will serve: Residence Q'Apartment House ❑ Commercial [] Trailer Court B —Motel ❑ Other-❑ <br /> Number of living units. .. ... Number of bedrooms-.,/... Number of baths ..,�__ Lot size _.......... '�I.K.:11_'e-ft............... ! f <br /> Water Sl pply: Public system El Community system ❑ Private ❑ Depth ro Water Ttible l`D_ ft' - !�l <br /> s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay(]. Adobe E.,Hardpan <br /> Previous Application Made: (If yes,date....:...............) No New Construction: Yes ❑ No.2-- FHA/VA: Yes ❑ No I' <br /> t TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe►mitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation................r.Materiai..._......_.....,._......................._--... <br /> ❑ No. of compartments...............1....._..Size......_........_._......_... --Liquid depth-'�.. --------------Capacity,,.!................. <br /> Disposal Field: Distance from nearest well_.$7.�k.!.....Distance from foundation-----/g1.__1------Distance to nearest lot line.._: I�'...... <br /> ---------------•Len each line------------- Width of trench........._...>S�d.-:._._... 4K . .............�GQ� Number of lines...............) Length of g <br /> Type of.filtec:meterial_....i 4'.CK.....Depth of filter material.........1�. 0S 0.:!....Total length..................... !......... <br /> Se go Pit: Distance to nearest well' ��Distance from foundation.........Q__�___.Distance to nearest lot line_....r3...�... '� <br /> a,44 Numbe; of pits+k...../ ......Lining material..-_ t? .k...Size�Diameter..._..Xe...-_..Depth--------. -�-? <br /> Cesspool: Distance from nearest fell......:..........Distance from foundation.._:_.......1......Lining material.-......-------------.._------------- ` <br /> ❑ Size: Diameter. =-------�- ------------------Depth_...-.,...............................r....•-•-•-•.Liquid Capacity._.:........................gals. <br /> Privy: Distance.from nearest well...... ................. -------........k -Distance frominearest building.......................................... <br /> ❑ Distance to nearest lot line.......................'............;................................,..................................................•------------------ <br /> - 10 <br /> Remodeling and/or repairing (describe).......... .. : ------ <br /> ----------•---•--•....-•-•-•-------------------••-•-------••..--------------------------------•- --------. ....._ -- - .. ............................ <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 /> I <br /> (Signed)-----------------------------��----�ll�i�-G�a�---�....-- .---......... O_.r.........( wner and/or Contractor) <br /> Title ........... <br /> (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------Al..... ; ..................... DATE._--- 61......... F-?..................... <br /> REVIEWEDBY............................... .................................................... .............................. DATE........................................................... <br /> BUILDINGPERMIT ISSUED..............'....•.......... ..................... — ... --------- DATE..................•--------- •---------------------------•- <br /> Alterations and/or reeommo scions:. �tt-ff ........ <br /> ..... <br /> ---------------- , s ....E?.. .......... ..._.n.....lr 'P r---- �- �- .................................... <br /> ......................... `a ......... -- .... ------• ;�. - e- .. ............ <br /> .-.-�<� r........h.•/_.L�_.. ..-.-Z. - _?.......;....ram.� � -,° _' ``'-� --.... ' <br /> A <br /> Ri ��►/tt-gr� 'L'i(1x s. r`c ...C` .a_ .✓f-�:��1GR�i-. -s-�.-s�.l¢�/' l` <br /> /�-a''5...._..._L.. ... ....... - tt"'.......................................... ..... <br /> ---�i r .� <br /> FINALINSPECTION! BY:........................................ < V-, > Dote . ------.................._...........----------................---....... <br /> 0 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 91h Street <br /> Stockton,California Lodi,California —"''Uanteoa,California tee Tracy,California <br /> ES 9 REVISED S•59 2M 5.62 ATLAS <br /> I <br />