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------------------------------------------------------- <br /> --------------------------------- --------------- ------- A,. ]CATION FOR SANITATION PER' Permit No. <br /> -------------- ------------- --------------------------- (Complete in Duplicate) <br /> ---------------------- This Permit Expires 1 Year From Date Issued Date Issued ._!_ .-1_Z.-.1�3 <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--X-402.----------A-t W--!L Aa!y.. (.<,Jx �� N <br /> Owner's Name---v ---------- R-----------------------------"-----•--------------------------"----------•-•--•------ Phone( -71-�-0----- <br /> Address----------------------"-..&I S------------/.494-Ft_9_..------R-1C-- <br /> . <br /> Contractors Name---------- 1212,_f�_5.14.......1 N (0 YPhone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths ___r___ Lot size __-J�_._ (____.c�.4?G_________________________ <br /> Water Supply: Public system ;( Community system ❑ Private ❑ Depth to Water Table . ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No New Construction: Yes K No ❑ FHA/VA: Yes ❑ NOX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-kS-Q.......Distance from foundation----1_Q---------Matyial_. !U�' /_------------------------------------ <br /> No. of compartments__.-_--�r..__._______Size_... � ___Liquid depth____ Z-._--______.Capacity... ----- <br /> 0 <br /> Disposal Field: Distance from nearest well.."57P'__-_Distance from foundation-_--_./A'-_____.Distance to nearest lot line-----(5­ <br /> Number of lines______________ ___ _ ____Length of each line___________._b-Q.'-_.__.Width of french..-------- ..4!_"._ ------ <br /> Type <br /> __-_- .L <br /> T e of filter material___�i -_�:®-'------ <br /> yp .�-.1�..____Depth of filter material____.___._1_.���___Total length______________________ <br /> Seepage Pit: Distance to nearest well--------------------Distance from foundation....................Distance to nearest lot line__..--____.__..._ <br /> ❑ Number of pits______________________Lining material-----------------------Size: Diameter.......................Depth_-_....__.___--___.___.___.___.._ .., <br /> Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material.____-_____.._.---------------------- � <br /> Size: Diameter--------------------------------------De th---------------- ---•----- <br /> ❑ p -------------------------Liquid CapacitY----------------------------gals. <br /> Privy: Distance from nearest well-_____.__""_________-----------------------------Distance from nearest building----------.-------------------..-______-_. <br /> ❑ Distance to nearest lot line-------------------------------------------------"-----------"•-•---"- - - <br /> Remodeling and/or repairing (describe):_.___.__(2p-ra�.__. ______ ------a.__��-s.�.! <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­-------------- <br /> I <br /> ------------------------- <br /> I hereby certify that I have prepared this 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)_.__._.._ ____O. r- S,r_ __(O ner and/or Contractor) <br /> ----------------------------------------------- <br /> B :--------- Title <br /> Y ( ) . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.._ � eN <br /> ---------------------------- <br /> �- DATE____Z�___/ �_�."��---------- <br /> REVIEWEDBY-------------------------------------------- ------ ........ ------------------------------------- DATE------------------- -- ------- ---------------------- <br /> BUILDINGPERMIT ISSUED----------------- -------------------------------------------------------------- ----...------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations: <br /> -------------T- - <br /> ------ = --------- --------- ------ ..rte- ----- ..._ <br /> C �" - `= ---------------- <br /> c-7 -c .tom---................. ------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:...`��__,. . '^�............... Date......./- .. 14 <br /> ,� ., `//.! ,�---'-------------------- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CD. <br />