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FOR OFFICE USE: <br /> f X� <br />-------------------------------------------- <br /> ---_-------- APPLICATION FOR SANITATION PERMIT Permit No. 211AL1 n.. <br />--------------•-------------...------------------------- icate <br /> (Complete in Du l <br /> P p ) Date Issued _�_�___��-�' � <br />----------------------------------------- ---------�-.--- is Permit Expires 1 Year From Date Issued <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 LOCATION...... Q ... L.!..p--ce -------------------------- <br />.- Owner's Name........................................Nee., ..'aw..•---A.<_e-Aaa---.._...-- .--............._.---••----------... Phone......nt7m---------_------------ <br /> Address................ rS� ..:........-•--............................... -•------•- ........................................................... <br /> Contractor's Name-- ?._s6J& !-f --.., .,-,J.tlCa---------...------...................................... Phone- ---f� <br /> Installation will serve: Residence,)g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/... Number of bedrooms _- Number of baths .---- Lot size _-_�` - .TE..,/-------- ------------- <br /> Water Supply: Public system 21 _Icommuriity system ❑ Private ❑ Depth to Water Table 4!6. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No ❑ New Construction- Yes ❑ No [p- 1FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 244 feet.) <br /> Fptic T Distance from nearest well-----------------Distance from foundation....................Material------------------------......................... <br /> No. of compartments--------------------------Size------------------------- _---Liquid depth--------------- .--- --- Capacity <br /> �spposal f field: Distance from nearest well__NjbA_C----Distance from foundation.. 9.r......Distance to nearest lot <br /> � Number of lines------I------------------ Length of each linej_'40___!_---_-I/-_--.Width of trench.._,oZ. a <br /> � p d Type of filter material ---Depth of filter material_-_-- _--------Total length-------------- .Q......---- �] <br /> /�t rte.-- Q <br /> Seepage Pit: Distance to nearest well-140*e---____-_Distance from foundation-.Z.K_.__-_-..Distance to nearest lot line----_-f-v <br /> 70 <br /> RNumber of pits----j----------------Lining material.R&ck------"Size: Diameter---zz,!_..._Depth--Z4__`_.-------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation.-------------------Lining material....._----------.---._-_-__-_--_---._ <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-------.__-_----__--_-----__-------------. <br /> ❑ Distance to nearest lot line- ----------• -----------------------------------------------------------------------------*----------------­----------------- <br /> Remodeling <br /> -- •--._......_- <br /> Remodeling and/or repairing describe}-------- --- --- ---------.-._-....-_-_. -------_-___-__-.--__---. <br /> --------------•-----------------•------•-----------.........-- �� ` f - .............---------------- <br /> •. ............................. <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 la and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-. Az4p---- -- by--* - - ---- - - --- <br /> �. <br /> . - - - - - Contractor) <br /> By:--------------------------------------------------------- ----------------------------------•----- -- - - -------(riifle)----------------------------------------._ :.- - -------------- <br /> (Plot plan, showing size of lot, location of system in relation to we buildings, efG., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--,-,'-) DATE �� --.�--..... <br /> ---- --- -- - -- ----- --------------- <br /> ---------------------- <br /> REVIEWEDBY------------------------------------------ -- -------------------------------------•-------------------.................... DATE--------•-•----...-•---...--------------------------------- <br /> BUILDING PERMIT ISSUED------------------ -----------------------------------------____............................... DATE------------•------------------•---------------------------- <br /> A e ations and/or recommen atio s:___,--------- ---- r --------------------- <br /> IV <br /> --- ----- <br /> - ----- - --...- <br /> ---------- <br /> --- - ------ <br /> -----------------------------------------------•-------•----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------- <br /> FINAL INSPECTION BY: � ----- Date--.--- t!J( <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 /> E8 51 REVISED 8-59 2M 5-61 ATLA8 <br />