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�OFF 1�1�fS <br /> ................ .........--- <br /> ............... APPLICATION FOR7 SANITATION PERMIT Permit No. <br /> ------------------*------ <br /> ................ ------­---- ............... [CornpI4.%'in Dupricafe) Date Issued <br /> ........­..................:........... ...... this Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son 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 /> 1 r _1 .......... <br /> JOB ADDRESS AND LOC TIONIP47 ---------------------------------------------------­-­------------­*------- <br /> Owner's Name Phone......................------ <br /> 40, <br /> 119�--- ---------------------------------------------------------------------------------------- <br /> Address_ ............. ...... .. ......................................... ................................................ <br /> Contractor's Name ......... . .............t............ Phone.............................. <br /> . <br /> 0' <br /> Installation will serve: Residence EI Apartment House [I CommeATIMe'Trailer Court 0 Motel 0 Other [I <br /> Number of living units: Number of bedrooms!r� Number of baths -/-.- Lot size ..............I.............. <br /> Wafer Supply: Public system ❑ Community system EI Private a-5apth To Water Table 99�jpfltl 01 <br /> 4` 'Character cf soil to a depth of 3 feef: SandO GravelEl Sandy Loam [3 Clay Loam O ClaYEI Adobe 12ro"Hardpan 0 <br /> Previous Application Made: (if yes,date....................I No JR- New, Construction: Yes 0 No24o1`PHA/VA: Yes 0 No ZZ l <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> Sep '1c TankDi tance from nearest well_________________Distance from foundation__.----------- <br /> ..Material............................................... <br /> 1 S <br /> No. of compartments_-_------..........._Size--------- �!,,..............Liquid depjh-.........................Capacity-----_----------_---- <br /> AWIRW �Al- <br /> Disposal-Field" Distance from nearest well----_...... Distance from o-'nclation....................Distance to nearest lot line____...,____._-,. <br /> Number of lines...................................Length of eat ine---_-----------------_-------Width of trench._........__-__-_-__...__..___..... <br /> Type of filter material...............--------Depth of ilte'r,material...........I—........Total length------__---___-----------__-----_---_---- --J <br /> /__ isto [of line- -/.. (A <br /> See P* Distance to nearest well.--/.M- -------Distance f fgyndafion,./Z9._... D' t_nce to nearest /.4...... <br /> Seepage <br /> Number of ............Lining ...Size: DiameterT.0007.......... <br /> I <br /> Cesspool: Distance from nearest well.................Distance from foundation....... .......Lining niaterial.................................. <br /> 11 <br /> Size: Diameter.-:1 --------_Dep th�..........__------_ .. <br /> -------------- _.__..Liquid Capacity.. •---•-•......--••-•-•....gals. <br /> 1 %'' 't <br /> Privy- Distance from nearest well....... <br /> "..1. ..................-------------Distance from nearest building.......................................... <br /> 171 Distance to nearest lot line...................••--_---•• )_­_...-•-•------.......-----• -----------._._-__.-....----•-•------•--=--••--•--_-....-• r <br /> d/or repairin.9 (descrilpe):----__---------- - --- --- Me ............. <br /> Remodel ng I ------- <br /> ...................... .. ........... -- -- ----••-----••---•...... <br /> ---------------------*-,***--------------------- <br /> .mss <br /> ............-----------............ ......... <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.Ind rules anZddullafions of the San Joaquin Local Health &)Stric+. <br /> ----------- .... -------------­- .............. <br /> ----JQwwrg-wa�iW Contractor) <br /> ------------------------ ----- <br /> (Plot <br /> By:......11-I..... ......V......... ............. <br /> tSiqned�......... <br /> n be placed an reverse side). <br /> (plot plan, showing size Ic ocation.o.f.system in ation to wellc, buildings, etc., <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. C!�:.,0000V—A—•------- --•---•--._.....--••-------------................ DATE..-- nlb_-43:'_--.__----------------•--- <br /> REVIEWEDBY....................._-------_ t k, -------------_------- DATE-----.............................................. <br /> BUILDING PERMIT ISSUED............---------------------------------------J-- ------ DATE...........................................­­­...... <br /> Alterationsand/or recommendations:.----------------_------•--_--------------------------------------------------------------------------------------------------------------------------- <br /> ..........--------- ................... .................... .................................................................................................--------------------------------.................. <br /> ................................................. <br /> ------- <br /> ................................ ......................................................................._­­----­-------..._..__.._..._...__............----- <br /> ._..----• <br /> .................................. <br /> ......................................................I---------------------------------------- <br /> ............................ ....... .............................­­_­................. <br /> FINAL INSPECTION BY:.-_C_,.......t4�------..................... Date_...._ --------------------------............. <br /> \]� k '.. '( <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West On <br /> 130 South American Street k Street 1 Comore Street 205 West 9th Street <br /> Stegitton,California 1.941,California Manteca,California Tracy,California <br /> ES 9 REVISED 13-59 2M 5-62 ATLAS <br />