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r <br /> .......t.... ..................". ............... APPLICATION FOR SANITATION PERMIT Permit No. <br /> _ __ __ (Complete to Dupficaf,e) / /Y <br /> `" This Permit Ex fres 1 Year From Date Issued 1 <br /> - ' -- "" Date Issued .._.._ <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work h�3 descr bed. <br /> .2-241 <br /> This application is mode in compliarife with County Ordinance No. 549. <br /> 5'700 E - nitC-,F-A-V F— <br /> JADDRESS AND LOCATION_.J_.D._r /AJ __ L <br /> Owner's Name-.­AA-F= -•----•-- ...... _.. ...................... <br /> � -...�f3�3I?�N_.._...i �,�l.�L�N- .FIR. .-......�c�oo <br /> Add 4!7 ------ <br /> Phone--•-•-------...---•- <br /> - �1! 1D <br /> �... <br /> Contractor's Name --••--- T -. .... F �.C...... F1.��C- .............. ..._-.._ _---...---.-...._one.-•-------•--....._...__-.......-- <br /> Installation will serve: Residence ❑ Apartment House ❑ Comrnerciel ❑ --•----�-••---•••••�••_••�'�""' Phone......................._.._._..... <br /> g S R� �Ni aper CT MoR1___ other [I� Chfoo[� <br /> Number of livin units: _. N� � e rooms. — — • <br /> ._._-_ Number bath -.....�ot srze ....... N <br /> Water Supply: Publics stern Community system - -----------------------------• -` <br /> y ❑ ty ys ❑ Privets Depth To Water Table .k__-W9 `I <br /> Character of soil to a depfh of 3 feet: Send Gravel0 <br /> ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan ❑ 0 <br /> Previous Application Made: Of yes,date. <br /> ....... ) No �New Construction: Yes Q-1`lo ❑ "FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P <br /> Septic Tank: Distance from nearest weil_JQ--©..Distance from foundation.....1v...__..M terial_CDNC <br /> No. of com artmenfs..._. 2 _.__.. ;-._--•-. <br /> p '�-'---------Slze-..S..A-9----•--•-•-....Liquid depth....`,12..�-. <br /> ___.._.Capacity... 00 0 <br /> Disposal Field: Oistance from nearest well.../0.0--1 istance from foundation....../Q..-..Distance to nearest lot line I—* <br /> (� Number of lines.........157 <br /> ------=--------Length of each line.-��;�--��.'�-:�idth of trench....._...�<,,._....__.._____• <br /> +Type of filter meterial._... Q....- _ - <br /> C- Depth of filter materiel._... ..".......Total lengtf�--------X06 Q...-.•-+ <br /> Seepage Pit: Distance to nearest well.. �Q"Q_•-.•-Distance from foundation..... -`" <br /> - - l�_.___DistancQ,to nearest lot line.........._. <br /> (� Number of pits...:... ------------Lining m'aterfal._FQK•K...Size:-0igmeter.2 :.•- �� <br /> Cesspool: _Distance from nearest well----------------Distance from foundtenia <br /> ation______ __________ __Lininel: -------- <br /> ❑ !Size: Diameter.............................. ......Depth ---------- <br /> - :.._ <br /> Lining m-------Liquid Capacify.... ..------••----------..gals. <br /> Privy: Distance from nearest well....:................. istance from nearest building , <br /> Distance to nearest lot line..._._.," .............. <br /> ••_._•_"••."-"••-•-•_• <br /> --------.....---------------------_................................................. <br /> . <br /> Remodeling and/or repairing (describe)--------- -----6VO 1__`_-_.Fn <br /> ------------ <br /> -•-------------...... ............._............ • P ."11 --.iom....1. ,1kK <br /> - <br /> ............... ............._.......................-......................._..........................................................................--................._...............•---'.... .--•-- <br /> I fterebyy cert' that 1 have prepared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances,;ffaaf/awand rules a gule ions of the San Joaquin Local Health District. <br /> (Signed). �� . <br /> . . ------------------------- -----------•-----'the'•............... <br /> .(Owner•and/or Contactor} - <br /> gY= ..............••----•---••---....................--•--.....--•-•---...._........._._._..............._.......... <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed'on reverse side).. <br /> FOR DEPARTMENT USE ONLY <br /> • <br /> APPLIATtON ACCEPTED BY....... f. .. .. ....... ....--.-_-.-•---•------•------------------------•-- DATE.. •���. .-.6.Zr--..... r <br /> REAhVE'D BY.............•"--- <br /> --------•---------------------------• DATE._..------------......_..... . <br /> BUILDING PERMIT ISSUED__-............ <br /> ----__---- - ----.........-........... <br /> -••--•-•--------------_.."... .------•-_.__........_.......--•-----------.-- DATE.........-_......._..---- ------------------•-•--•...------ <br /> Aharetions and,qr recommend'ations:_____________•_•-••"•__-.•--.-__-- --". <br /> .-.. . --.. .. f.�...... _�_ ._.-----•--� t -�_ J: <br /> ---------•--•---......-7:,:x4. . ........... . <br /> ---...---•••---•••......•----- -.................... <br /> FINAL INSP Data. _....•--...._. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American sorest 300 Welt Oak Street <br /> • 124 Sycamore Shah 203 Wool 9th Skeet <br /> Stockton,Callfornle Loll,callfomio <br /> Manteca,Callfomla Tran,Cnlifornio <br /> E9 9 REVISED 8-59 2M 5-62 ATLAS <br />