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FOR OFFICE USE: <br /> - -----------._....... -------_.......... <br /> �i <br /> ---.-.......... ...... APPLICATION FOR SANITATION PERMIT Permit No. .../ Q.._5. <br /> - ....... ------I....------ ----------- (Complete in Duplicate) /o <br /> _211111111111,- ............... . - -- This Permit Exoiros 1 Year From Data Issued Date Issued ........!-� <br /> �1J, f, OS7- Zr 0-7/ <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.:_4(�,�F _ 7 ,0100V yow7w ©/V <br /> JOB ADDRESS AND LOCATION-�1� �A'� �ar..�bX /L� '7cr-._,..ZE,D_..174 e y� Qy� <br /> Owner's Nam <br /> a e_-.. . feP...-`�Q/1�...�Yk^5+�1/TT ..................................`t:-:.... ..... ------- Phone......-----.......... --------- <br /> Address...............0�... B .. �.Z - ' .�!4X'FQ. .y.C°g11.FQ 'e✓!�l-... .................-... -................ <br /> ...-....... <br /> . <br /> Contractor's Name,----:-. <br /> ------ ...... .......................... Phortan ?Z.-----..-- <br /> Installetion will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer -6ethrt e Motel ❑ Other ❑ <br /> Number of living units: _/....:-Number of bedrooms ./._. Number of baths _-1... Lot size ...ie�s-..dnt'E'srA................... <br /> ...... <br /> Wafer Supply: Public system ❑ Community system ❑ Private RKDepth to Wafer Table ........ ft. _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2" Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date._ ................I No e New Construction: Yes ER"No ❑ FHA/VA: Yes ❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> `.- T - - - <br /> eptic Tank: Distances from nearest well_s'3.`.QQ�...Distance from <br /> ® - No. of compartments.........z.............Size-. /w... -------Liquid ...C..6.._..Capacity...ZQ.0..tf'BL. 0 <br /> Disposal Field: Distance from nearest well_0=00!..-Distance from foundation._.!! 1........Distance to nearest lot fine..690...... <br /> 0 <br /> ® - Number of lines.............1---------------...Length of each fine-..-------61P-!-----......Width of trench..........Au..N..._--_----- VY <br /> Type of filter material---lf�?.CK........Depth of filter material_----J`_........Total length...........4.Cs.`.................... Z <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------.-------...Distance to nearest lot line--............... <br /> ❑ Number of pits.-:.........-------.-Lining material..................----Size: Diameter.......................Depth............................. <br /> .... <br /> •Cesspool: Distance from nearest well.................Distance from foundation.._...............Lining material.... .............................. <br /> Ct <br /> Size: Diameter.--------------------------.........Depth.........._'rt":-' <br /> ..... .................----...Liquid Capacity....._.--.................-gals. Q <br /> Privy: Distance from nearest well.......... <br /> r......:._.___.._._._._.._'_..Distance from nearest building......................................... v+� <br /> ❑ Distance to nearest lot line....-......... <br /> .................--........----...----------....-----------...------..._.....--------......-------........----......... <br /> Remodeling and/or repairing (describe):........olp.P._......!y..........7 ..+!!?¢"P..CA14. <br /> °---- .--------------------------_...-.......- _....................I.............- - -'......_.................------ .................. <br /> .................. ..... ...-----------....--•-—........-........----_-------------- ... .----.._.......-_-.... ---........-•----------......................................---------------........... <br /> -----..... .................................................--- ........._..----_....__...---------...... -------------- .................. _.. <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ` <br /> erdinances,.5ta+e laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).......... ,. ....lDlJrntaC�.1s�-1/---_ rifdk.............:--.-----------_-----.....................(Owner and/or Contractor) <br /> L�+ ls,r...-=4 <br /> --- - .4---- - .------_.....----------------------------------------------(_Ti+le........_..............-------- <br /> ;. •• - - ) <br /> (Pbt plan,swing size of tl_cat of system in relation to wells, buildings, efa., can be p-teem reverse sie�' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ..... . . . -............ .•---.....------...._ DATE_L.O--/- CY- ......... ........... <br /> .REVIEWED BY.---.......... ............................._..... ...._............. -.-......-.............................. DATE......................... - ....-..... ...... <br /> BUILDINGPERMIT ISSUED----..................---......_.............-----........----------------------------------...- DA•TE__......-----•---------.._...................----... I <br /> Alterations and/or recommendations:.---.....-....... ............................--------......------........._....------t <br /> ---......................._........•-------- <br /> ...----`-------__.......----..-_.._........_-------.......................... <br /> ...------- --..__-.........-----......_..........................._........_........._...................................... , <br /> FINAL INSPECTION BY:- ?y?2f:.Lf...-- Date���. 2 2- .. .__.. .,T A. <br /> SAN JOAQUIN LOCAL HEALTHDISTRICT Q;4 <br /> 730 South Amedwn Stmt 300 Wast Oak Srrvw 724 Symmers Stmt 205 West 9th Streat <br /> Stockton,California Lodi,California Montow,Colifarnia Tracy,California <br /> ER 9 REVISED 6.59 EM 5-61 ATLAS <br /> 1 <br />