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FOR OFFICE USE: <br /> _2 <br /> /"/Ala ._-.......:...... <br /> --- . Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> ...................... ........................... (Complete in Dupricate) �lf(,/b <br /> ------------------ ......... ­-----­--- --- ------- This Permit Expires I Year from Date Issued `r3- <br /> Date Issued .. ...... ..... --- <br /> I / �r 3- r&0 -_T0- <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. 60-"ew <br /> o 0 S' � -5 L- <br /> JOB ADDRESS <br /> ..................................... ---------- ------_---_---- -- <br /> Owner's Name_..... . ......... Phone..--X" —7.?"Y <br /> Address---_----------- ...+P1...... <br /> PC........................ Phon <br /> ---------- <br /> Contractor's Name.*...4V,4,.._!�V..V...*.^. r�. 1 11 ........ <br /> Installation will serve- Residence Apartment House 0 Commercial 0 Trailer Court L] Motel [] Other [] <br /> Number of living units: _A?�Number umber of bedrooms Y--Number of baths ./-.- Lot size ............... <br /> Wafer Supply: Public system [] Community system El PrivateX Depth to Water Table �V. it. <br /> Character of soil to a depth of 3 feet: Sand L] Gravel E] Sandy LoamClay Loam [] Clay [] Adobe E] Hardpan❑ <br /> Previous Application Made: (If yes,date.... .......... ) No [] New Construction: Yes El No 54_ FHA/VA: Yes E] NoD <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-6y__-__Distance from founJafion.].O. ------Material.. <br /> No. of compartments...Z................ Size..5- <br /> - A <br /> . .Licuid cep�h ..=;S.S7 ---Capaci.,-.- <br /> Disposal Field: Distance from nearest well--,5 ' r, <br /> O..-..Distance rorn founclation....-A0......Distance to nearest lot line <br /> Number of lines_ ....--Length of each line-- <br /> Width of ............... <br /> Type of filter mate,i`,l'.73ef_A.. Depth of filter materif Total length. ............ <br /> Seepage Pit: Distance to nearest well .....&,o Distance from foundation.-.k s........Distance to nearest lot "ne-------f 77." <br /> Of <br /> 0. Size: <br /> A Number of pits. / ..............Lining material...I ---- Diameter.... Depth .. ............... <br /> Cesspool: Distance from nearest well......... ... ...Distance from foundation ............. Lining material.... .................._.._..-_...... <br /> ❑ Size: Diameter.................. ... . ..... ....Depth............ _------------------------------------Liquid Capacity. r <br /> 1 -1 <br /> Privy: D:slance from nearest well......................... ......................Distance from nearest building._...................................I b ; <br /> ElDistance to nearest !of line.......................... .. .... .........................................................................---------------------- <br /> Remodeling and/or repairing (describe):-- -... 4-..... ............................................ <br /> ....................................................................... -----a---ve-,—�-- -------- ---------------------------------------------.. ... <br /> ..........................._................... <br /> .... ....... <br /> .......•------•--•---------•...................•--•--•--•-•--......--•-._.... ........ ------------ ..................... <br /> ....................... .............................................. ......... ..... . ---------------------------------------I., ............... .............................. .............................. <br /> I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County% <br /> ord;nan r ce trlif S. apd rule and regulations %;thr oa uin Local h District. <br /> toq__ <br /> S <br /> ................ onf ractorl <br /> . . . ........... .. ........ <br /> (Signed)..-- PILL ------- ..... 1111111iffin""I -C <br /> ........................ . ...... .......... . .. ...... ------- -- - ---- <br /> By:. ...... . .................... .............. ulliii <br /> (Plot plan, showing size of lot, location of system i1nrelati o� wells, buildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY .41--o-------------------- <br /> APPLICATION ACCEPTED BY---- <br /> F-W -r-..------ -----•---.-------------- <br /> ------------------------------ <br /> DATE.—J.=117..7 <br /> REVIEWED BY........ .................................._4 ... ......... ------- <br /> ........................................_ DATE-...- ..---•-•---.... <br /> ..-------------••--•--------------.-- <br /> BUILDING PERMIT ISSUED..............................................---------_----•---------•-•- --------------------- DATE.. . <br /> ............ ------------------------------------ <br /> Alterations and/or recommendations:..-./- ........ <br /> •-?4_;............... ....... .......... <br /> .................................... <br /> 4E <br /> ---------------------...... .......... ......... ...... ....... ................................... ... ........... ............................................................................................ <br /> FINAL INSPECTION BY:.... H-- -- � - .-- _- -- Date__4._-11._ �...P.................. ................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycomoris Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ed-9 AcV1690 0-59 11 CU. 2.&'60 <br />