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I -N VJ I 1L­L 1101_: <br />----------­-------------------------- -------- --------- <br /> --------------------- ----------------------- ArICATION FOR SANITATION PERn Permit No. .... ............ <br />----------­--- --------- ------------ ----------------- (Complete in Duplicate) <br /> ----------- --------------------1--------- --------- Date Issued ...L� <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in compliance with County Ordinance No. 549. A+Nr S Iq <br /> JOB ADDRESS A D LOCATION f .. .....WNTIE <br /> Owner's Name.... <br /> --------- ----------------­----- -------------- -------------------------------------- ---- Phone <br /> Address.......... va....... 44-N6------rlt�A <br /> ..J_�Z� Q_ _. - <br /> - --------- <br /> Contractor's Name__f0AN_Tj'E, _C_1q F tip 7 ................................. <br /> --------- ------- ------------------- Phone <br /> Installation will serve. Residence El""Apartment House'El Commercial El Trailer Courf E] Motel [:I Other <br /> ❑1 <br /> Number of living units: <br /> Number of bedrooms ,*_I_ of <br /> t__ _ __S__ _.ItoL <br /> umber size ------ k_1 <br /> Water S4pply; Public system Community system El Private <br /> Depth TO Water Table Z5—ft. <br /> Character of soil to a depth of 3 feet: Sand ff-_'Gravel E] Sandy Loomo? Clay Loam 0 'Clay Ej Adobe❑ Hardpan <br /> ❑ <br /> Previous Application Made: (Iflyes,date.........._ "a <br /> --------) No Ej�,/New Construction: Yes ET No El FHA/VA: Yes L] N <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cessp6ol permitted if public sewer is available w�fgin 200 feet.) <br /> Septic Tank: Distance fr f m nearest well-----------------Distance from foundation--------------------Material....... <br /> __K]' ................................... <br /> >re AJ C— No. of compartments----------------------_-Size---------------------------------Liquid depth-_-----------------------Ca acit ...................... <br /> Disposal Field: Distance fr m nearest well-_-------------.Distance from fou'ndation--------------------Distance to nearest lot line. QP <br /> -X� ................ <br /> f jN Number ,f lines--•--------------- Length of each line ----- <br /> Type of filt material---------------- -of filter material-I. ---------------Width of french---------------------------------- <br /> i,- ; ---------;Depth --------------Total length------------------------------------------ <br /> Seepage <br /> ength------------------------------------------ <br /> Seepage Pit: Distance foinearest I <br /> Numbe�/q'f jkpits----------f---------- <br /> well------&�> ---!Distance from foundation_____--/0 DjstancQ tp nearest lot <br /> ,-.-.Size: Diameter_------f?----------Lining n1aterial ---.Depth------/------------------------- <br /> Cesspool: Distanc ijbm nearest well.,-- <br /> eif t, ------ Artance from foundation--------------------Lining Lining materiaL.,---- <br /> ------------- <br /> El Size: Diar�6fer------------------- --------------------*-------- <br /> j------I-------J.Depth--------- -------------------- I <br /> �A I Ill.�- I _t. ---i------------------Liquid Capacity---------------­-----------gals. <br /> Privy: Disfance7from nearest well Mfan e from nearest building--------_-----_ <br /> —-------- ----------------------- ------------------ ...... <br /> 0 Distance5dnearesf lot lin ' <br /> A -A--------------------------- <br /> Ig fL <br /> -----­-------------I------------------------------------------- ---- <br /> Remodeling and/or repairing , escribe):--- ---------------------------I-- <br /> .................... CLCX -------------- <br /> ./-- -------- J ------ --------------------I----­-----­----- --------------- <br /> ----- <br /> ----------------------------------------------------f <br /> ----------------------- <br /> V ---------••---- <br /> ( <br /> -I.... -------------------*------------------- --------_------------------------- <br /> --------------------------------- <br /> --------- <br /> ----------------- -------- -------:_�------------r7l------------- ---------------­----­------------- <br /> r d this I,i. <br /> I hereby,cerfify that I have Oepa -application and that the worewill �e done in accordant San <br /> ordinance )oaquin County <br /> and State laws, and-Irlu es �n ulatio,s of the District. <br /> ISan Joaquin Local Health <br /> (Signed).- <br /> -__ 2, /� <br /> _1 _------------------------------------------------------------------- ------- <br /> 9wner and/or Contractor) <br /> By:--------------------------------- ::: <br /> ----/- ; <br /> -- ---- _2- - ------------------------------------- ---------------------(Title)----------------a--------- <br /> (Plo+ plan, showing size of lot, l4cation Of system in relation to wells, buildings, efcan be placed on reverse side). <br /> c <br /> �Fdlk DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY'!__._'kT_t_?,b DATE------ <br /> , — 7--------------------- ---------------------------------------- <br /> REVIEWED BY <br /> BUILDING-PERMIT—ISSUPD—.- ---:----------------------------------- ---------------------------- ---- DATE--------------- ------------------------------------------- <br /> Alterati'o-ns"-and/or—r�e-c—o-m-rendaf ions:------------ —------------ <br /> - ------------------ ------_-------_----- ---------------------- <br /> -------­------I---------------------------------- ---------------- ------------ -------------------- - ---- -------- <br /> -----------1----------------- i ------ ----------------------5�=..------•- ­.............I----------------------- <br /> •--.`--- <br /> ... .. ----------------- --------------- ----------- ---------------- ----------------------I-------------------------------- -------------------------------------------------------- <br /> ----------- ------------- --------- .......... - ------ -------------------- --------- -------- -------------I--------------------------------------------­-:_-------------- <br /> ----------------------- <br /> -------------­­............. ............ ----- ----------------- --- ------ ----------- -- - ---•-------•-----. ---------------- ----------------------------------------------------------- ............ <br /> FINALV INSP <br /> Date- ------------- - --------- -- <br /> ----- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1,30 South American'Strbet 300 West Oak Street - 124 Sycamore Street <br /> 1 205 West 9th Street <br /> :3 <br /> Stockton,Coliforn--a Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />