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FOR/OFFICE U <br /> Permit No. <br /> ..... ....I.............. ....... . . APPLICATION F6R ,SANITATiON PERMI-r <br /> ....................... <br /> ................. (Complete in Duplicate) Date issued ----flz�.4 2 <br /> ..................................................... <br /> .. This Permit Ex fres 1 Year <br /> . . _ _ From Date Issued Cc�/ -- Or— -5,2 <br /> ....................;e-.�................ .. . .. 0, <br /> Application..ation 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 m d in co.m�plian ith County Ordin c No. 549. <br /> ............. ........ <br /> JOB ADDRESS AN <br /> . C TIC <br /> Owner's Name-----------=------- ...............- <br /> ----- -- - ----.-----.-.----.- <br /> --------- -----------------­-------------------------------- <br /> - Phone.....-.........................-.-.- <br /> --- <br /> Address.................................../ <br /> . Phone................................... <br /> ................................. <br /> Contractor's Name-- ............................ - ---- - ----• ----- <br /> Installation will serve: Residence C1 Apartment House [3 Commercial E] Trailer Court C] Motel 0 Other El <br /> Number of,living units: Number of bedrooms _c-Z Number of baths Lot size ------);It------------------------ --------------------- <br /> •)o�ater Supply: Public system 0 Community system E] <br /> Private 2--biapth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel L3 Sandy Loam D Clay Loam El Clay[3 Adobe 9__<.,rdpan 0 <br /> :.Previous Application Made: jif yes,date- - --------_1 No Construction: Yes 0 No Ef-�HA/VA: Yes [] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-(No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> .............Distance from foundation................--..Material-------------------­­.......................... Z_ <br /> t'Ic. Distance from nearest well.... Liquid depth.------------------------CaP8ciity------................. <br /> J��W, compartments--------------------------Size--•------------------- --- ----- <br /> m N-o. of ion....................Distance to nearest lot line................. -M <br /> ----Distance fr�m foundat* <br /> s <br /> k� --------------------- <br /> Distance from nearest well..... <br /> ------------------------------Length of each line.---- --- --------------------Width of french.............. <br /> Number of lines <br /> Type of filter material........ ....Depth of filter material...__.______...-----Total.............-Total length-------------- ---- ------ <br /> .............. I <br /> st lot line_,529 <br /> c <br /> ;i <br /> .__Distanc <br /> to nearest <br /> t ell /040 Distance/fiTim foundat ---- <br /> Seepage Distance to nearest ... .4 Linin-g rnaterial.(/ .3.. ..... .....-------- L <br /> . •-Size: Diameter..3 <br /> Number of pits--- ----------- material........----------------------------- <br /> Cesspool: D'fstance from nearest well-----------------Distance from foundation....................Lining <br /> 0 size: Diameter------- ---------- ------------------Depth----------------------------- .. .................Liquid Capacity----------------------------go" <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- - <br /> . ................................... ...................................................... <br /> 'Distance to nearest lot line............................................. <br /> ... .. .................................................. <br /> Remodeling and/or repairing (describe):................................ <br /> ...................................................................... ........ <br /> ........................................................... <br /> ........................................... <br /> ............................................................................................................... ......................................................................... <br /> .............................................................. <br /> ............................. ........................................................ --------------------------------------------...... <br /> ............................---------------------­----- in accordance with San Joaquin County <br /> I hereby ceo;fy that I have prepared this applicatio-in and that the work will be done----------- ------------------------------------------------------- <br /> I �vs, and rules and regulations of the San Joaquin' <br /> ordinancesLtSf -e Local Health District. d/ <br /> n.r.an or Contractorl <br /> . .............. <br /> (Signed}_ ------------- ---- ?...... ----- <br /> .......... ..i_ <br /> .............. <br /> ....................................... reverse side <br /> By:------- an be pl�a e on <br /> o e <br /> (plot plan, showing size of lot, location of system in relation f ildings, etc., C <br /> FOR DEPARTMENT USE ONLY <br /> -------------- <br /> .................... <br /> ------- DATE------- —------------------------------------........ <br /> . . ............................................................................ <br /> APPLICATION' ACCEPTED BYAV DATE. <br /> ....................... <br /> 4!�7 4................................... --- <br /> REVIEWEDBY---------------------------....................................... DATE_......................................................... <br /> BUILDING PERMIT ISSUED.......................:...................•---•- ----•---- <br /> ...................... ................. ------ -------- 7-1 <br /> —---------- ........................................................ <br /> ns:----------/_Is_7 .•.... ....... <br /> Alterations and/or recommen4atio <br /> ,} •-•••............................................................ <br /> .. .......................................................................................... <br /> ............................. .................. 4 ..........! .............................................................. <br /> ..............;............... ....................................................................................... ';...... .... ........................................................ <br /> A .............................................................................. <br /> .............................................I.......................................... ............i-�.............................................................................. <br /> ......................................!=...................................................... <br /> ................. <br /> Date_ ...................................... <br /> FINAL 'INSPECTION BY:;--- -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 124 sycamore Street 205 West 91h Street <br /> 130 South American Street <br /> TracCalifornia <br /> Stockton,California Lodi,California Manteca,California y, <br /> 9 REVISED 6-59 ZM 5-61 ATLAS <br />