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---------------- APPLICATION FOR SANITATION PERMIT ....... <br /> ........ ---------- Permit No. <br /> ----------------------- --------------------------- (Complete in Duplicate) J_/ <br /> ...................... --------- - ............. ..... This Permit Expires 1 Year From Date Issued Date Issued ...fl.'­2._�l <br /> Application is hereby made to the Son Joaquin Local Heh District for a permit to construct and install the work.herein described. <br /> This application is made in compliant with County 0 i st 7 <br /> Mnce No 549 <br /> I O/�- ------------- <br /> JOB ADDRESS YID LOCAT <br /> 4,.r_e 0 -_4 <br /> ---- -------*------------------------------------ <br /> Owner's Name.- <br /> ---------- .......................................................-------------- Phone>&Z-.- - :.i�.7...... <br /> ,5-�2 ;2Z <br /> Address-------------------------- ........... ------------------------------------------------------------------ ---- ------------------------ <br /> Contractor's Name____-_c-jt2?--L,1 P <br /> Installation will serve: Residence E] Apartment House E] Commercial El Traile,765It 0 Motel [I Other Z�� <br /> Number of living units: -------- Number of bedrooms -------- Number of bath <br /> X - .-- Lot size -----4112-1 ------------------------ <br /> Water Supply: Public system [community system Ej Private F] Depth to Water Table,�Ti _ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe Ej-_'H_ardpan Ej <br /> Previous Application Made: (If yes,date_______________._.-) No E] New Construction: Yes �r_­N, Ej FHA/VA: Yes ❑ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted u6lic sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wellejVe, ---Distance from founclafion-Ze.- I......_M at <br /> No. of compartments------- --------- ---Si"_,1I prom <br /> ----------Liquid depth__ --------Capacity... Q4!.. . ... <br /> Disposal,F I eld: Distance from nearest well_)414—_ :��Distance from foundation-/-4--t........Distance to nearest lot line-----------�5 .. <br /> Number of lines___._--/'--- - Length of each line------7��................Width of french-,,2- " <br /> sp--- ------- --------e--------------- <br /> Type of filter material _Depth of filter material-__. --S-----------Total length_.__.___-___ ---S__________________ <br /> Seepage <br /> --S------------------ <br /> Seepage Distance to nearest well--)lSl)lt-lp------Distance��m f9priclation.../40........Distance to nearest lot line--.-'-5 If <br /> At: 1 1— , 1 01----- - ------------ <br /> [��r Number of pits-----a------------Lining materia I.2b -Size: Diarriefer-_33..... Depth-------A--%S7 ............... <br /> Cesspool: Distance from nearest well.................Distance from foundation-------------_-----Lining material__...__......_..__...___..__.__...___ <br /> ElSize: Diameter--------------------- ---------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well.------------ --------------------------- - -----Distance from nearest building-----_--__--------_-__-__---______.._.._. <br /> ❑ <br /> uilding------------------------------------------ <br /> 0 Distance to nearest lot line-------------------------------------------- — <br /> Remodeling <br /> ine---------------------------------------------- <br /> Remodeling and/or repairing (describe):--J __4 v ------ <br /> -------4v�__ <br /> ---- --------k--- ........ t(------------------------------------- --------------­------------- <br /> ------- -------- - --- ------------------------------------------------------------------------------------------------------------------------------------ <br /> .... .................... ----------------------- <br /> -------­------------ ---- ---- ------------ ---- --------------------------------------------------- <br /> ---------------------------------------------------------------------------------- <br /> I hereby y that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> c <br /> .es, <br /> a <br /> ws <br /> ordinances, ne- ,.;,s. and rul s and re�afiions of the San Joaquin Local Health District. <br /> (Signed). 4a- ------- -- --- -- ------------- ........ ..---------- --- ---------_--------------- ------- - .(Owner and/or Contractor) <br /> By:-------------------------------------------------------- - - _R_ ..............-------(Title)---- ------- ----- <br /> (Plot plan, showing size of lot, location of s Ofern in relation to we, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- <br /> --------------------------------- DATE------- ----1-6...................... <br /> REVIEWEDBY---------------------------------------------------------/� <br /> V----------------------------------------------------------------- DATE........................................................... <br /> BUILDINGPERMIT ISSUED.........................................................................................----------- DATE............................................................. <br /> Ahertin pd/or recommendations_____________________________ ___ ___ __ ---------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> .............................................................................................................. <br /> ------------------------------------------------------------------------------------------------------------ ----­---------------------..................... <br /> .............................................................................................................................................................................................................................. <br /> FINAL INSPECTION BY:- - Date--- ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-61 ATLAS <br />