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FOR OFFICE USE, <br /> -------- ----------_..`. -------- ..........--..... <br /> ... - - - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> .... ---- <br /> / s��L°.- (Clete in Duplicate) <br /> -` - .-._.... -- (Complete Date IssuedThis Permit 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 described. <br /> This application is made in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION----,1.v..,7n.- L'---��G�X-Z-�-,�-i"✓.-".J.__----- -,`� t �� -.-.. -_-- <br /> Owner's Name.-✓ �' ---`-- .._._s::..-------`•--.-..._----.-. --...-- ------....__-__.-------------------------.-.... Phan <br /> Address 7 `' ` � c _ <br /> v - ` - ........ <br /> Contractor's Name_r�-:"-.-._ ...--- - ------------------------. - Phone.............................---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> gl�c1—FY <br /> Number of living units: .1--- Number of bedrooms __Number of baths---- Lot size ..... ......................................... <br /> Water Supply: Public system ❑ Community system ❑ Private EYbepth to Water Table/.7k- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam❑ Clay Loam a Clay ❑ Adobe❑ Hardpan❑ <br /> Previous Application Made. (If yes,date._......._;:..__I No ED,- New Construction: Yes ®,'No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �,- <br /> (No septic tank or cesspool permitted if public sewer is agaiillabfe,wi hin 200 feet.) r�"t. `t(/- <br /> Septic Tank: Distance from nearest welt_ .-- _:-.--.-Dis#ante from.foundatyon..._L.t__.Matenal-011, y_----.-...._--.J• .- ' <br /> No. of compartments-._:.-._z-::::......Size-J4-X...N.'{_::�.Liquid depth___----�' .. <br /> .. .-.- p .-__-.-- <br /> Disposal field: Distance from nearest well m .---.-Distance from foundation.... 0........Distance to nearest lot I�e-.._: <br /> Number of lines-----------. -___.....--_-Length of each Iine..L.4(9-_e.''.�- ....Width of trench.......: :........_--._-_.... <br /> Type of filter material_ n ° '�'(�-De th of filter material.-_-- �_---'.Total len th.._----- ------ -- �y -.e-=----. <br /> Seepage Pit: Distance to nearest welLf _..-..,Distance fr m foxy dation----/--.('r-_-.-.-.Diistaanc�e,to nearest lot lin lf.......- <br /> < _ia. Depth.___2 I , <br /> Number of pits.-. ...Lining matenal----- .1.-Size: Diameter__ .-: _--...---. ----- ---- -- ------ <br /> Cesspool: Distance from nearest well-_............... from foundation.-..-----------_.Lining material .._...._........................ <br /> •`❑ Size: Diameter---------..-....-----._---.------Depth----.--.----------------_------.. .......Liquid Capacity-. gals. p� <br /> Privy: Distance from nearest well_-----_--.--.. ......--_.---.-_._....--_.-Distance from nearest building-----_-__-._-------__w............. '1¢ <br /> ❑ Distance to nearest lot line--------------- ..----------- ----- .---......-------------------...........__-.----- ..........-'--------------------- -------------- <br /> Remode{ing and/or repairing (describe):._...... ....-'----- ........--.-............... --.........- WW-..--....-------------........................... w...................-.-.-...... 9 <br /> --------------------------"------------------------------------- .......--................................... k <br /> ._.......-------------------------.................---------......----------------------------------------------------------------------------------------------­­­----I.......__ ­......... .......... <br /> I <br /> _---------------------------------- <br /> I hereby certify,that I have prepared fhi�application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--.1-(� - _^�-gig.7--- C._ `r= t (Owner and/or Contractor) <br /> By:------- -----_------------------------------------'-- --------- - ....-_. ..-. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... G-1,- - t?�`- --------------- DATE--- f Ll' -------- <br /> REVIEWED BY---.......------__........ - .... -....... - -- -- -- ------------- DATE----------------_--_-.......................... <br /> - <br /> BUILDING PERMIT ISSUED.....----- ................... <br /> ..-..... --------...-- DATE-- ......--................... ..................... <br /> Alterations and/or recommendations: ........----------.___. .............................................................--........................................................... <br /> ------ <br /> ...................-_----------------------........-,...........-..-.......----------.......---....-------................ <br /> ...................._.._....-......_.._._-......................................_--.....----...........-.....-- ---------------- <br /> FINAL INSPECTION BY:------"-7"---._ . ...--- .:.I_` .�'---- Date..... -..._-/-. .-..-_:..- --------.-.._.............. <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 144 Sycamore Street 405 West 9th Street <br /> st.Aton,Cellfornics ? Ladi,California Manteca,California Tra,y,CDGf.rnla <br /> ES 9 REVISED 5-59 3M 3-'63 F.P.CD. <br />