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FOR OFFICE USS: <br /> - t �.................. <br /> !YI Permit No. .. .. .._ .. <br /> APPLICATION FOR SANITATION PERMIT �6 <br /> .-...� (Complete in Duplicate) Date Issued 1,c;.. a <br /> ..................._-.. _ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliances with County Ordinance No. 549. <br /> JOB ADDRESS LOC T Ne_ft..to.---4-�- ..� s .--------------- -----._--- <br /> `��i4�C -L.�....... --"--- - -".- QI-V....-.-------........... Phon6•f'10�-1-- ,�5... <br /> • Owner's Name... . .. - <br /> Addres:_ ..4. .&.z ' ...... `"`... ,✓r.�rr - 99. el...--5-'f�c ortl <br /> Contractor's Name... � _•--.�.- -- _--7------------------ ------ Phone................................. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ MotDl ❑ Other is <br /> (,(fC/t( uesst <br /> .>�PQ.` <br /> f Number of living units: -...... Number of bedrooms........ Number of beths......... Lot si2040 x <br /> .ze ... . ... <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water'Table,.Si. ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe& Hardpan Q <br /> PreviouslApplication Made: (if yes,date...................)'No %- New Construction: Yes E] No - FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tarl cesspool permitted if public sewer is available within 200 feet.) _, <br /> I <br /> Septic Tank: Distance from nearest well.................Distance-from foundation--.-._.__-_-.-Material . .._..............---......--....___---- <br /> ❑6i(cs1r No. of compartments._.............--.-...:Size..........._:..:------ Li -- <br /> '--'-- quid depth.... ........ ........Capacity.............:...... <br /> Disposal Field: Distance from nearest well.NQdl.I -Distance from foundation../V........-Distance to nearest lot line.-:5 ...... <br /> ` Number of lines.---C1-�- ...-.-. _ Length of each line...-3.S.-* Width of trench/-4. <br /> !!ii........................ <br /> Type of filter material.-. -.- ...._Depth of filter meferlal...j- -----........Total length---..35..................... �* <br /> ' Seepage Pit: Distance to nearest well-/(1Q.AI�.-__Distant from oundafion--1,Q....-...-.Dls+'ice to nearest lot line...��.... <br /> . <br /> 4 59 Number of plts.'C0_..........Lining material .....Size: Diameter...t33...._.......Depth_2,TE..'..i.................. <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 and/or repairing (describe):........ . ------.... . ...... _-- <br /> .......... - <br /> O <br /> .---------- - ---------- ---------- .......................-------......................... <br /> -----------------............__.............. -------------- --- - - ---........................... ------- ---------------............................--------------.............................. <br /> I I hereby certify the ave prepared this ap licetion and that the work will be done in accordance with San Joaquin County' <br /> ordinances, State laws, nd ules and regulah of the Sap Joaquin al Health District. Contractor) <br /> A <br /> (Signed).......................-- ---- .... ..-- --- .. ---- - - _ e and/or tor) <br /> By: - .... '-' -C...-•-... <br /> ..... ---- .........--.................(Title) . ... -- . ._... ...............I.-........ <br /> ..._. <br /> (Plot plan, showing size of lot, location of Sys m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---.!_..c..---- '-...:...-.............--'--------------------........... DATE.....-`.....-^' 4- --------._............... . <br /> REVIEWEDBY.--- ------... --'--- ._...---..--- ------------- ................... .----- ---- ---......:.....!DATE.........' ' . ---... --.._.'................... <br /> BUILDING PERMIT ISSUED--- ' ....--�-�-"-�- ------...-._.........-...# <br /> �.w .... D TE--'---- ----- rte- ---------------------- <br /> - <br /> Aker tions a d/o scommendatiens:.-.Ls1--A- --.- ------- --- --------- ------ <br /> ......_... . ..... .. 1.-... .------ .. ..... . .... - - -- '--'--'-- ............................... <br /> ..................------'---------_.............�................----'-"---------'------'---.-._...... .---'---------------------- --.. j...................... ........._..... . . <br /> FINAL INSPECTION BY:..-ltt.RVDt-C.:-................._. Date._!-- s..`_6. ....._................-. - _ ............ <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1001 9,Massillon Ayo. 300 West Oak Street 120 Sycamore Street 205 West 9th Street <br /> Sfoeklen,California loci. California Manteca,California Tracy,California <br /> E.H.9 2M 1-62 Vanguard Press <br />