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APPLICATION FOR SANITATION PERMIT Permit No. _`..13 3 <br /> (Complete in Duplicate) o -I- <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued ------"_:".--,__---=-6 <br /> Application is hereby made to the San Joaquin Local Healfh 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 AICD LOCATIO ' �f1 ------ dv 'r � ------------------------------------------------ <br /> --tip <br /> --=--- -------------•--------------------------------------------- <br /> Owner's Name---- ------r=---- ------------ � h ---- -- --------- ----- ----------------------------- <br /> Phone <br /> Address /� -------------- <br /> ---------------------------•?---•-•---•-`---- <br /> IContractor's Name----- � ---------------------•--------------- .Phone-------- --_-------•----------- 4 <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial El Trailer Court , Mo#el.,❑ Other [j ! <br /> �+ i <br /> Number of living units: 147 Number of bedrooms lZP,Number,of.baths`e- Lot size --------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ®!eptln to Water Table <br /> Character of soil to a depth oil3'Ifeet: Sand ❑ Gravel ❑ 1 Sandy.Loam �d Clay Loam E] Clay ❑ Adobeiardpan E] <br /> Previous Application Made: Yes ❑ No [t?--`New Construction: Yes- P-� No ❑ FHA/VA: Yes ❑ No 9;.— <br /> TYPE OF INSTALLATION AND-SPECIFICATIONS: a <br /> 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: <br /> i Distance from nearest wDistancefrom � Mate "aI <br /> � s _ Ca--pac�i'yf-No. of compartments--- -----------------Size liquid ---------_ -__.---_-_-_% 1J[ . <br /> 47 <br /> Disposal- Field: Distance from neare t welLE1 -_Distance from foundation---AQ_____-_"-"-Distance to nearest loj line-__- -__-- <br /> g o s r <br /> Number of lines---- ----------Z-._-_-_-----------------Length Len th of each line%��"��0__��°Width of trench."""�--_-"-""-.--__='--_-"._.- <br /> Type of filter material/_jr__X _Depth of filter material----/00-----------Total length_w124_40-__-_-----_"-s'_-------- <br /> j 1 <br /> Seepage Pit: Distance to nearest well--- Distance fr m foundation_-_/ ____.---.Distap�a to nearest lot line ' .~-_-.-_ <br /> ®� Number of pits----5-.------ Lining material___A40 Size: Diameter--.' ____..."--Depth__-v =""`______________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--------- -------4----------------- <br /> Cap <br /> ------- -_-_-. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity -----t-------gals. <br /> Privy: Distance from nearest well---------------_------------------------------ Distance from nearest buildin -------------------------. <br /> F ❑ Distance to nearest lot line------ -------------•--------------------------------------------="-------------- �«• <br /> Remodeling., and/or repairing...(describe):--------�--- --�-^Ct-- --------- -•---------------------•---------•- -----•-:------------ <br /> •--------------------------•------------------------ -----------------I_......-----"-,-:-------- <br /> ------------- <br /> ----- <br /> --•------------• -------------------------------------------------------Y__--------------------- __ ------------- <br /> k <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 ru es and regulations of the San Joaquin Local Health District. <br /> - � i' � � ractor� <br /> ----------------------- r Cant <br /> (Signed) � - �---- ---------- _�. <br /> B --------------------- le} ' `- - _, <br /> # ' I <br /> (Tit <br /> (Plot plan, showing size of lot,�location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> e7 1 I <br /> APPLICATION ACCEPTED BYa---b-.C - - ---------- ---------------- - -------------------- DATE �f -a------------------- <br /> REVIEWEDBY - ------------------- DATE------ ----------- ---- :-- --•- .--'--------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------.------------ QATE <br /> tL <br /> Alterations and/or recommendations:--3- 4.�"�O�.--..-S�rt---=4 p - ------ <br /> ------- <br /> ---- <br /> t <br /> ------------------------ ------------------ <br /> -----------------------•_--------------------•----------i---- <br /> v <br /> ----------------------------- <br /> -------------- <br /> - ----------------------------------------------------'------------ <br /> FINAL�INSPECTION BY:----� ,�----------- ----- --------------------------------------------- <br /> SAN <br /> Date_:.---Q'_ �—__0 •- ---------------------- <br /> -� -- - ---�----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American. Street 300 West Oak Street 132 Sycamore Street 814 North ••C•• Street <br /> Stockton, Califorriiay Lodi, California J Manteca, California Tracy, California <br /> ESA--2M Revised 8-'59 FRCa. ' <br />