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FOR OFFICE USE: / �/ <br /> .................................................... <br /> .... ...... .... ........................... APPLICATION FOR SANITATION PERMIT Permit No. _Z.VI W. <br /> ..............- ------......---..................................... <br /> (Complete in Duplicate) <br /> Date Issued ... <br /> ...................... This Permit Expires 1 Year From Date Issued <br /> .... ..... . Y <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 compli nce-with County Ordinance No. 549. <br /> fir:! I_ iy 4K6�`,j' (/ <br /> Jf B ADDRESS AND LOCATIOIJ'�SCI.r. hL_a.P..4..._... _ --- . ` <br /> Owner's Name_.... .....'_^_:!`:r7e._/�e.!Lei...... _........_-............-..._•.......•'---__........... Photro....­?-------- �•• „�' <br /> Address------ 71st'^-��c--_...._..................-------............ ----•-..........._.--__..__......._ _ —._.—_—...._----------------------_...-------- <br /> Contractor's Name....L/..- x2-- `-S.Qate'- ...---- -_................................. <br /> Installation will serve: Residence &Atpartm-ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: A..._ Number of bedrooms _—a. Number of baths _. Lot size ........ >S'Q.... .s,r...._..»._......,.0 <br /> Water Supply: Public system ❑ Community system ❑ Private Er Depth To Water Table�MJ ft. 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [IClay Loam ❑ Clay❑ Adobe Hardpan <br /> Previous Application Made: (If yes,date._ _-- ---......) No 121SaNew Construction: Yes Q'hb ❑ FHA/VA: Yes ❑ No 8� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well-----------------Distance from foundation...................Material-......................._................... <br /> No. of compartments._------.................Size._..............•...........•.-.Liquid depth.........---.--.-.......Capaclty_........_-._.__- <br /> Disposal F. Distance from nearest well.................Distance from foundation.----.._..........Distance to nearest lot line__........... <br /> 4 Number of lines..................................Length of each line......_......................Width of trench.... <br /> Type of filter material..............._........Depth of filter material.......................Total length........... -.. <br /> Seep ge Pit: Distance to nearest well...IAA . ......Distance from foundation.... ....._._ 's�gnce to nearest Iot.Ii�.... <br /> - <br /> Number of pits._._..- ............Lining material....Q22.6t.[.t__--Size: Diem( .� _r!..........Depth._':Y......-x..-7."�.C..... <br /> Cesspool: Distance from nearest welL.........._....Distance from foundation....................Lining material-_---_.._.._-._-........._...._ <br /> ❑ Size: Diameter.-----------------...................Depth........................__......................Liquid Capacity-...—..._...._.......gels. <br /> Privy: Distance from nearest well.............---------------------.------ -----Distance from nearest building..-------__............._........... <br /> . <br /> ❑ Distance to nearest lot line.............'-'----_------------o�-----^------`-'--._...p.........._...�_n.........----'-'--'----"-'---•........M...----.......... <br /> Remodeling and/or repairing (describe) .... <br /> ;...... ..... �I. CES--�.�W......J- --•••••--p' -•- ......•-- <br /> 7.........•...---'-...--_...---_....'..-------.-.._.................._".............."..-'- .__.`_..` .................. WLs_...._-----..............................._...- ------/ <br /> 1.4.E 2._-fi -.��l1tA-L--..]'t.T...... Y7N_.. 1!kt......laim�KF_Dy�brf;ln ......._SA/_6.....Z5. <br /> �.._... - -.........---•-----------'----'- ...----_---------------------- ...........................................---------------------...- ----------------------------Tf.&42n./ <br /> I herebymortify thst I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, tate laws, and rules and regulations of, the San Joaquin Local Health District. <br /> (Signed)... .- -�- ,�-s ) wk _ � .' ...... <br /> Til ial.... .........(Owner and/or Contractor] <br /> _..... .- . .._......_... ........- <br /> By:..... ... .... . .. .. ..> ti-- ._..- -- • •-- ...-- -(Title).--- -' -- --��'-�# - ................ <br /> (Plot plan, showing sizeat, location of system in relation to wells, buildings, etc., can be plaead on rowrse sid ayr� <br /> -y-�7 FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY.......J..i.k�.4�'- ----- .--------......-_.....--------- DATE..--`Q_ ._- ........ <br /> REVIEWEDBY............................................. .. .......... ..._...-------.....---------------------........... DATE................._----------------_-------------.------ <br /> BUILDINGPERMIT ISSUED..........-................----------...--......._-----------------------........ DATE............__._.........................---_....._- <br /> Alterations and/or recommendations:..........._............................._-----------........-------......................................—............................ <br /> .....--'-- <br /> ..............................................................................-....................................... ---...................................._..._._........___._.............. <br /> ---------.------------...-----------_------------------- ------------------------------ -------------------------------------------.......------------------------------__I _...._.-----------=....... <br /> FINAL INSPEC - '........ DeM........109 z./....�. ?.2..- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 190 Seath American St,"I 900 Wert Oak Anel 124 Sycemem Street 205 Wur 9th street <br /> Stadlen,Califemia Lodi,Callfarnia Manta,",Callfernia Trary.Celifornla <br /> `. E9 9 REVISED B•59 2M 5-62 ATLAS <br />