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FOR OFFICE USE:.y <br />--------------------------------------------------------- <br /> -------------------------- ------------------------ APPLICATION FOR SANITATION PERMIT Permit N6,-.-.,.l <br /> ----------------------------------------------- ------- (Complete in Duplicate) bate-IssueLN��­`/­­`­�_2,- <br /> -----------------------------------------— --- --- This Permit Expires I Year From Date Issued <br /> Application is hereby made'to the San Joaquin Lcitbl Wealfh'Disfirict for a permit to construct and install the work herein described. <br /> This applicati6n is'-made in compliance wit -, ount�Ord'in,ance No. 549. <br /> JOB ADDRESS AND L V <br /> -OCATION ---CjR1 --------------------- ------ <br /> Owner's Name___-____-F-6-Cry ndus_p_�—------------------ ----------------------------------------------- Phone__ <br /> ----------------------------- <br /> Address...........P0..•---_73 ax-----......70- _A,4 N-T i ----•----------------............ ------------------------------- <br /> Contractor's Name----------ARVAI --------------------------------------------..----•--•----------•-•---•------=_�---------------------- Phone.............................. <br /> Installation will serve: Residence ;7Apartment House F]. Commercial F]', Trailer Court ❑ Motel 0 Other 0 <br /> Number of living units: . ------A-K <br /> ----- Number of becIr6'oms Number of'baths /----- Lot size ---- -----------! Z <br /> Water Supply: Public system [] Community system [] Private W--Depth TO Water Table ----- ft. <br /> Character of soil to a depth of 3 feet: SandtrGravel [I Sandy Loam ,Clay Loam E] Clay E] Adobe[] Hardpan O'i -()i <br /> Previous Application Made: ;If yes,date____________________) No E] New Construction: Yes El No El FHA/VA: Yes E] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is prailfe within 200 feet.) <br /> vx <br /> Septic k: Distance from nearest well____5�..Distance fro m foundation.../0---------M6rie6aI__R_JSb_W.Q. .. ............... <br /> ---------------size Z a i ----- <br /> - <br /> No. of compartments_.__ 30"r__X_.�>�_ iquicl d6p�h--------- -------•-Capacity-----pac t <br /> Disposal Fielcl:'• Distance from nearest well__,�O----Disfance,from foundation---/(9---------Distance to nearest lot line.... ........... <br /> Number of lines........ -Length of.each line-------------- 3_0.....Wi dth of trenck.-.., ---------- <br /> Type of filter materiaI..*Z?0_CX.TO' taI length............3,,6------------------- <br /> Type of filter material._R� I <br /> Seepppvpit: Distance to nearest well____,] :�------D-istance'from 'foundafion-jC7 <br /> ............DistaQce to nearest lot line._.... ........ <br /> NurrID4 6f pits.......i'_/---------—Lining�mat�rial_-__/ Size. Diameter_.6.)(-K---------Depfh__­.__g----_----------- <br /> Cesspool: Disf;nce ro; nearest Distance;f'oe foundation_______________. 9 material______________________-__-_-_.---_-_ <br /> eirial-------------------------------------- <br /> � <br /> ❑ <br /> Size: Diameter------ -------------- ---------------.Depth----------'-----------------------------------------Liquid Capacity....................I-------gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building.____.-..___.__.._..._....._____.-.:__.._. <br /> Distanceto nearest lot line-------- ---------------- -- ------------------•---------._.....-•------•---•- ---•----------- --....----••-----•----......_.-• -•-•-------- � <br /> { � 4, Y <br /> Remodeling <br /> ----7------------1-........ ----------------------------------------------------------------- <br /> Remodelingand/o.r repairing (describe):---------------------------------------------------------- ------ --------------------------------------------------------------------------------------- <br /> -------------------------------------k..t.......I--_------ -------------------------------------------------.............----------- ...... <br /> ­------------------............................................... <br /> --_--------- -----------------------------------------------------------------------------------------------•- -----------------------------:------------------------------ <br /> ---------------------------------- ... -k------ <br /> ------------------------------------------•------------ ----------------------- <br /> -- <br /> I hereby c *fy that I have 'prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S la and rules: and regulations of the San Joaquin Local Health District. <br /> -------------------------------------------------------------------- ------------ __.-_.(Owner and/or Contractor) <br /> (Signed)------ <br /> ---------- <br /> BY:--------------------- --- -----------------------------"---=------;:I ---------------------------------------------- ------------------------------------------- ................... <br /> (Plot plan, showing size of lot, loq;afion of system in relafion.fo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- -0----- ---------------------------------------------------------- DATE-------- 77417410--- <br /> REVIEWEDBY------------------------------------------------------------------------------"-----------------•---•------------------------ DATE-------------------------------------...................... <br /> BUILDINGPERMIT ISSUED.......-----------------------------------------------------_­.................................. DATE----------------------------------1-­------------------- <br /> Alterati and/or recommencrations:--------------------------------------------------------------------------------------------------...... -- ------------------------------------------ A <br /> ep�. <br /> TTla and <br /> �r F- M--------eflr.v� <br /> -------------------------------- <br /> ----------------------------------- •.. ---------:5,H0_L4j_N--------------------------------------------------------------------------- <br /> -------------------------------------------------- ........... -------------------- ----------------------- ------------------------------ -------- <br /> -------------------------------- ------- -------------- --- ---------------------------- ------------------------------- ---------------- ------- ----- <br /> -----­-------------------- <br /> FINAL INSP Date.---- -0----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />