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FOR 04J-C'_t USE: <br />--------------- 7, <br /> - ------ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. 10AYS <br />-------------- ------------------------------------- <br /> ----------------------------------- (Complete in Duplicate) <br /> - ----------- <br /> ----------------:---- ----------------------------------- This Permit Expires 1_Year From Date Issued Date Issued ------ <br /> Application is hereby made to the San Joaquin Loc'al 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 /> JOBADDRESS AND --------- -----------------------------------------------------------------------*­------------ <br /> Owner's Name--- ---4-47-s-e?----------C 1;Z-------------------------------------------- --------------------- ----------- -------- Phone-----•--------- --•---------••---- <br /> Address <br /> hone------------------------------------ <br /> Address---------- -------•.:----------------------------------- ------------------------------------r-----------------------------------------------------------------------------------­----------- <br /> Cont4actor's Name------------efP7,0_ ._7:,_ ---------------------------------------- ---------------------------------I----------- Phone.®-_4$77a_4/,6 <br /> Installation.Will serve' ',Residence Apartment House [] Commercial ❑ Trailer Court E] Motel [:1 Other [I <br /> Number of living units: J--- Number of bedrooms -,?-- Number of baths _A__ Lot'size 'I-49AIK---1496F----------------------------- <br /> Wafer Supply: Public system E] Community'syttem E] Private p�Depth to Water Table <br /> Character of soil to a depth of 3 feet: 1. Sand E"j Gia-vel El Sandy Loam [] Clay Loam 0 Clay [3 Adobe [6-'Hardpan ❑ <br /> Previous Application Made. (If yes,date--------t.�........ No - New Construction: Yes �No E] FHA/VA: Yes [� No Ej <br /> TYPE OF INSTALLATION AND SPECIFICAIIONS: <br /> (No septic tank or cesspool perniiffedl'if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest w'�Il---9a ----Distancefrorn f8u ati'n----199`-_Material--- ----------- <br /> 4V rid o --- <br /> No. of compartmerifs----&-----------------S12e-47 dep�fh------3'0------ ---------Capacity- <br /> A nearest lot line----a-----.0 <br /> --- <br /> ---- -------_---Distance to ne <br /> --- <br /> Disposal Field: Distance from nearesf,lell---?a Distance from foundation-_-0"0 <br /> of french-- ------------------------- UJ <br /> Number of Length of each line=_ZO---- <br /> Type of filter-patDepth of filter materials ie/R----------Tiallengfh__A�, ----------------7---------- --r-7 <br /> Seepage Pit: Distance to nearest well__,/09_4'.-0'___Disfance from foundatio6z---447______-.Distance to nearest lot <br /> Number of pits--- ------------Lining material .Size- Diameter_ .... Dep4�47AM Z <br /> Cesspool: Distance from nearest 'w' eil------------------Distance from foundation---.--_____.- Lining material_------------------------------------ 1 <br /> z' I - �'Depth h------------- Capacity----------------------------gals. <br /> F] Si e- DiaimefJ----- ------ - ----------!­--------------------------Liquid <br /> Dis I f,_-s-f well_________________- - -------------------_______._._____. .._Distance Privy: fance.from1mfrom nearest building------------------------------------------ o <br /> F1 Distance to nearesi lot line.: ------------------------------------- ----------------------- ------------ <br /> ------------------------------- ------------------------- <br /> pr <br /> --------------- <br /> Remodeling and/or - <br /> repairing .(describe) -----------A'1 --W-------941V_2/�- ---- <br /> - ---- ------------------------------------ <br /> - -- <br /> -----------------------------------------------I ------------------------------ <br /> ----------------------------------------------------------------- -------------/-\----------. -------•------I--------------- <br /> �,A <br /> ------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------------------------------- <br /> ------- -------------------------------------------------- -------------------------------;---------------------------------------------------- --------------------------------- ----------------- ------------- <br /> I hereby certify that I have prepared this application and that the.work will be clone'in accordance wig-San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin LocaITHealth District.'' <br /> (Signed)_,&7R-�Z e"e.,dr- <br /> - -------------------------------------------------------------------- <br /> By:--------------------- -------------- <br /> -------- ------------------------------------ --------- ------ -------(rifle)---to -,Oz!f .................... <br /> (Plot plan, showing size of lot, locatio'n of sysf in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ ------ ---------------------- ----------------- DATE------ _41 ---------------- <br /> REVIEWED BY_- ........ ------- ---------------------- DATE------------------------------------------------------------ <br /> -------------- ------ ------------ --------------- <br /> ----- ----- .......... --------- ------------- -- <br /> BUILDING PERMIT ISSUED_---------- <br /> Alterations and/or recommendations: <br /> ------------------ ZA-2/- - --- --------------------------------------------------------------------------------- <br /> - <br /> -- �,-4f -- I --- <br /> ------------------ ----------------------------------------------------- ---------------r-----------:--------------------:------------------------------------------------------------------ ---------------------------- <br /> ---------------------------------- --------- -------- ------------ ---------- ------------------------------------------------------------------------------- ----------------------------------------------------------------11 <br /> ------------------------------------------------------------------------------------------ ----------------------------------------- ----------------------------------- ------- -------------- ------------ ------- <br /> Date----------------------- ----------- -------------------------- <br /> FINAL INSPECTION B ----------- <br /> Y:__4'�l.......rSA N JOAQUIN LOCAL HEALTA' ISTRICT <br /> 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Maraca,California Tracy,California <br /> CS 9 REVISED 13-59 31A 3-'63 F.P.CD. <br /> �J <br />