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FOR OFFICE USE: <br /> ----------------- ---------------------- -------- <br /> ------------------ ---------------- - -------------- <br /> -------_____________________________________ ____._____._._ APPLICATION FOR SANITATION PERMIT Permit No. Irl-_------- <br /> ----------------------------------------------------I---- <br /> --------------------------------- ----------------------------- (Complete in Duplicate) ��/� //� f <br /> -- ----.--- This Permit Expires 1 Year From Date Issued Date Issued _____________71-__.. <br /> D`I(— 0,1,o­07Application 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 wi+h County Ordinance No. S49. JET /N7Z�,p�e— y/ OF i.PANT �XW4`a4/. <br /> J08 ADDRESS AND LOCATION: G _. i�' . .. /Y .f�J--------=5 S/� :..._ F__. ! •. °�I�" ':.. <br /> Owner's Name_.._ E /rL,R� � 7� �-------- ------------------- Phone""s34' ! •--- <br /> AddressX ----------------------------------------------- /W-14 !Y-----------------------•-i <br /> Contractor's Name...-......��-.--/� !Q1S/6i!- s? .F j/Y .------------------------------------• Phone/,W_916.109........ <br /> Installation will serve: Residence 6?'Apartment House ❑ Comriercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�L. Number of bedrooms .e____ Number of baths _/.._. Lot size __z.5792!____ A&_0-{....... <br /> Water Supply: Public system RTI,Community system ❑ Private ❑ Depth To Water Table4 _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam Q�Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 2"' New Construction. Yes ❑ No Ejl*' rHA/VA. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 300 feet.) <br /> i <br /> Septic TankDistance from nearest well_,/_I/-Q/Vf_Distance from foundation._.1C!..........Materia?__i Vi 167E--------�----N---�-- <br /> No. of compartments..------.•'g---- -.._Size--------------------------------Liquid dep, h------- .---------------.Capacity�wQ._d <br /> `- 1 <br /> r Disposal Fie[ Distance from nearest welW_0&_ Distance from foundation._/Q_--_--__-_Distance to nearest lot line.-.�_..... <br /> r �� <br /> ® ` Number of lines------------�______________ __.Length of each line------�t a Width of trench___..��._....------------- <br /> &,W <br /> ________.... .� <br /> &, 1 Type of filter 'aterial..� __f____Depth of filter material-____/ .________Total length------------- ____.__.________.__._ op <br /> ! , r <br /> Seepage Pit: Distance to nearest well-----------------_----Distance from foundation....................Distance to nearest lot line----.-__-______-. <br /> ❑ Number of pits----------------------Lining material---------:.--- ---1-.Size: Diameter-----------------------Depth--------------------------------- ,D <br /> I Cesspool: Distance from nearest welly___ __ `_. 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 /> ----------------- -•------------•------------- ------------ <br /> - J - <br /> Remodeling and/or repairing (describe):_-_____`:�,� li�� _____ <br /> - �/ __---�'�f'T!C`_. C�9`�✓�:_.... 7-ViY�.__-, <br /> l <br /> -----------------------------•--------------...----------------------------•--------------•-----•----------------------------------- <br /> ----•------------------•--•-------•---------------.....---- -••--------------------------------------------------------------------------------------------------------------ri <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 Ae San Joaquin Local Health District. <br /> (Signed)--------•- '1_ . <br /> -•- -'--------------•----------------------------[Owner and/or Contractor) <br /> BY: =-*i- -- = AAte`''- ------- --------------------------------------(Title)• ----- t---------- , -------------- <br /> (Plot plan, showing size of lot, location ofof syse�relation to wells, buildings, etc., can belaced on reverse side). <br /> ). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ -�. ---------- ------------- DATE--- --------------------------------- <br /> REVIEWEDBY------------_--•------------------------------------ -----------------------------------------------------------------• DATE =... <br /> BUILDING PERMIT ISSUED-------------------------------- --------- DATE <br /> Alterations and qr re�ommerida ns:___.' � � � S--- lGC^ <br /> __.._______i... �_____.. <br /> .. � d C1 <br /> : _ .. <br /> ------------- <br /> --- <br /> -- --------- - - <br /> , �c,�---°-� r - <br /> /�`----------------- <br /> ------------ -'---------------- �,�` <" <br /> -- e _ __________________ ____ <br /> _______________ -------- ---------------------.._-_:_______.._____-______.____-__-..__________..-_-.-..._____.._._-__.._____-__.._--______.___--_..___.___-._..___-.._.__._. <br /> FINAL INSPECTION BY:. ` = Date--------- -_Ai <br /> I ---- <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 Lodl,California Manteca,California Trac <br /> N _ _ _.� y,California <br /> { ES 9 REVISE 8-59 2M 5-62 ATLAS 4 �F <br /> '' i �►�2-f��tt `'i Ijj <br />