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FOR OFFICE YSE: <br /> -------------- <br /> RAPPLICATION FOR SANITATION PERMIT Permit No. _ZY9.2- <br /> ----------------------------- -------------- (Complete in Duplicate) 1 //A_ <br /> -7- Permit Expires I Year From Date Issued Date Issued .... <br /> .......... --------------- This <br /> ------------- <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. <br /> JOB ADDRESS AND LOCATI0N.-___,'_Z2..2..6..... L------------------.........---------------------------------------------------------- ------- <br /> Owner's'Name------ ...........;rf--------- -------------7---------------------------------------------------- Phone_,H..Q...A/ <br /> Address------------------ .........e,S -----------------------------------------------------------------`-----------------_-._...-..-----.----•---•-•---.....--......... <br /> — . L1�A_3?..6._qV7_,1. <br /> Contractor's -------00-4.7 ------0----s6w.x------- ..............I.-"----...__......... Phone.,A <br /> Installation will serve: Residence [ff Apartment House [I Commercial ❑ Trailer 0�urt 0 Motel 0 Other C1 <br /> Number of living units: Number of bedrooms -A.. Number of baths Lot;size ------X­-/Jojo--- <br /> ................... <br /> I I . t , V <br /> Water'Supply: ,Public system Community system C] Private E] Depth to Wafer Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam El Clay Loam [] Clay E] Adobe eHardpan C] <br /> Previous-Application Made:, (if yes,date----- -------------) No [r­New Construction: Yes I—] No E3./FHA/\/A.. Yes [] No [I <br /> TYPE OF'INST.ALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool 'parmitted_if public sewer is available within 200 feet.) <br /> Septic-Tank-'. Distance from nearest well-_____________1.._Distance fro*m foundation____......._..?.....Material..-----------------------....................... <br /> ❑ A5)11571)y&. , No.'of-compartments----------- --------------size--­--------------------------...Liquid clepth­........................Capacity....................... <br /> Disposal Field: Distance from nearest well_JV,0&.6-Distance from iRounclation...A0. 4-----Distance to nearest lot line... <br /> 15Xi5T1tJ4 Number of lines----------- -------------------Length of each',line---------4rk-----:----.Width of trench---_------ ....... <br /> Type-of filter material...1?0_41,4C-------Depth of,filter r6terial------ -----------Total length---.......%5_1::i0------------------ <br /> . — I - —J* <br /> Seepage Pit.. -Distance to nearest well-N-PWr........Dista'nce from foundation___-9� ........Distance to nearest lot line__._..+%._.___-_ <br /> $%,-------- <br /> �rj - <br /> I ZXldii'iA�SN umber of pits------"/--.---. ....Lining material'! Diameter------;Size: _..Depth, --------- <br /> --------------- <br /> Cesspool: - Distance from nearest well..................Distance from folunclation-------------------'Lining material------------------------------------- <br /> Size: Diameter------------------F------------------ ------------------------------------------Liquid Capacity. -----------"------,----••-gals. <br /> Privy: 'Distance from nearest we.11--------------------------- Distance from nearest building----------------1.___1-------------------- <br /> Distance to nearest lot line.--------- ------- 2�---------­--------------- <br /> ------ ---------------------------------------------------------------- <br /> Remodiling and/or repairing (describe):--------;,RD_,D-------2Z�-------- ....... ................................ ------- <br /> . I I ? -------------I------------------------}------------- -------------I------------------------------------------------11----------------- <br /> ..................................6•--•------•--...------•--------------------------- <br /> --------------------------......I----------------------- ------ -----------­.......-----------------------------------------------------------I--------------------------------------------------------------------- <br /> IkI t <br /> ------------ -------------------- -------------........................­----......­-------------------------------------------------t:--k------II <br /> ------- --------------- -------11-11--------------I------- <br /> I hereby certify that I I have prepared this applicafion "d fhatAe work will be done in accordance with San Joaquin County <br /> ordinances,.Sfate laws, and rules and regulattons of the San Joaquin Local Health District! <br /> --- -------------------(Owner and/or Contractor) <br /> (Signed)._�--------- ------------- <br /> e------ ---------I------- 4-------- <br /> i Al.......(Title}' ...........t�'D / ---------------1111 ---------------- <br /> B ----_--------*466----------6A.- .......... <br /> y system42 -------------------------- <br /> (Plot plan.-showing size of lot, location a in-re-ia 'on to wells, buildings, <br /> relation etc., can 6ei'placedl on reverse side). <br /> �PNLY <br /> FOR DEPART ENT USE, <br /> ------ ---- DATE-------•- ---—------------------ <br /> APPLICATION'ACCEPTED BY------------------------- ----- .. ... ------------------- -------•------------ <br /> REVIEWEDBY...............-----------------:..............------- -----------------------------1•-----I----- --- I - DATE.. ---------------- -------------------------- <br /> --- ------------ --------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------*----------------—------------------- ------- DATE------------- ----- <br /> ------ ------ <br /> Alterations ond/orrecommendafigns-------------------- -------------- __ -------------------------­....... ---------- . . ...............------- <br /> ----------- <br /> -------- ---­-----------_--------- <br /> ---- - <br /> . . . 1 ---- - <br /> ------------------------=1----------•. .---•------------•--- ------------------------------------- <br /> ------ <br /> ................. ....................-­........ ­.-.---­-----------------------­-------------------- <br /> ------------------------------------------I-----------------------­--1­­­--­--.-.-.-.-.-.-.-..-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.............. <br /> -----------•,_-------- ------ .................... . . . ......... -- ------------ I -------------------- <br /> FINAL 'iNSPECTION BY.1_<;� Date.----- -- <br /> ,. ._. .. <br /> -- <br /> ---------- ---------------- <br /> %4!SAN'JOAQUIN LOCALHEALTHDISTRICT <br /> 130 South American Street 300 West Oak STf*ot 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad[,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 ZM 5-61 ATLAS <br />