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FOR OFFICE USE- <br />------------- ------------ Permit No. <br /> APPLICATION FOR SANITATION PERMIT ........ <br /> --------------------------------------------------- (Complete in Duplicate) Date Issued <br />---------------------------------- ----------I--------- This Permit Expires I Year From Date Issued <br /> st h work in described. <br /> Application is,'bereby mads to the San Joaquin Local Health District for a permit to construct and install the wor re <br /> This applicati in.is made '!D compliance with Count OrdA"nance Ny'. 549. <br /> LIRE <br /> (P-7 <br /> j6B-ADDRESS AND LPCATIO 7PW Iq 0 -----IqWK----/ j2--------- <br /> - ------ ------------------------------------- ---------------------------- <br /> Owner's Name---------/-/,e.......B.C.'ged----------------------------- -------------------- -- ------------------------------------ Phone.-I' .2.4)-ke <br /> -------- --­--------------4.7 <br /> Address------_ 7iel...Z.... ------------------------­--­------------------ ---------------------­-­---­-----------­-- <br /> Con'traciar's Na'me------- ------- 2 F/"P---e--- ---------------------_- phone....VI.-..7 _ZZf�..4' <br /> - <br /> Installation will serve: Residence Apartment House El-,,rCom mercial E] Trailer Court [__1 Motel ❑ Other [I <br /> Nu' mb;r of living units- Number of bedrooms Number of baths 1----- Lot size -----_------------------- <br /> Witer', Supply: Public system Ej Community. system [] Private ED- Depth TO Water Table <br /> Character:'of sail to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam El Clay Loam ga--bay ❑ Adobe[3 Hardpan E3— <br /> PreviousApplica+ion Made- (If yes,date__'._.._------ No 2---New Construcfion: Yes I-] No El FHA/VA: Yes 0 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> : <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Tank: Distance from nearest weII___-_5A-----Distance from foundation----„f d_______-.Material.rew P_X'-e./5Zr............J <br /> No. of compartments--------2-—-----------Size.3..)_5,__C7__._V_ .��,___Liquicl depth__ -12—--------capacity_- ----------------- <br /> field: Distance from nearest wetl-,-,,T-d----.-Distance from foundation-__1..Q___.__V-Distance to nearest lot line../d........ <br /> In, �------- --------------- <br /> Number of lines............;L------------------Length of each line- 1.0�- f;--L-0------Width of trench---,._a.. <br /> .5- 1---------­----- ----- <br /> Type of filter material.-J?AC�.e------Depth of filter material.___!___----------Total length------1 _10.. <br /> Seeipage Pit:. Distance to nearest well-__I-VQ__---_ _Distance from foundafion_44�..........Distance to nearest lot lineZ 4---------- <br /> Number of pits________I____________Lining material__._V-0 P_I�----Size: Diameter_X_-_f__.__5�_'.4-6 nearest <br /> /_�2__J_- / ----------- <br /> E3� - , epOrh......A_ ;;t------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> r'j Size: Diameter------------------------------------- Depth--------------------------------- ----------------Liquid Capacity---------------------------gals. <br /> I . % i <br /> Privy: Distance from nearest well----------------------------------------- ------Distance from nearest building--------.-.-----------••------------------ <br /> Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot line------------------ ------------------------ ------------------------I------------------------------------•---------------------------------- <br /> ---- - --I--------- <br /> ------ - <br /> Remodeling and/or repairing (describe):-------------- --- --- ----A/ -----------­-----­-----------------­------ <br /> ........... .......­.­---------------------­-------------------------------------------------------------------------------------------------------------------------------------- ----­---------------------- <br /> -------------------------------------------------...............;--------------------------------I-------------------------------------­---------------------------------------------------------------------- <br /> ------------- --------------------------------------------------------=--------------------------------------------- ------------------------•-------• ------•-•--------------------------------------------- <br /> 1,,,hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfate laws, and rules and regulations of the San Joaquin Local Health District. <br /> {Signed)..----- <br /> -------(Owner and/or Contractor) <br /> ----------------------- <br /> f ..47-AZ e <br /> A' <br /> ---------------------(Title)__4­70----- F/P--- <br /> ----------------- -------------------------------------------- <br /> By ---42 ...... <br /> -:- <br /> (Plot P1 it an,-showing size of location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> , " <br /> FOR DEPARTMENT USE ONLY <br /> TRlh <br /> APPLICATION ACCEPTED BY____-7 --------------------- DATE------- ------------ <br /> -_J------------- --- ------ --------------- ------- ------------------- <br /> RE�I�WED BY_------------------------ ---------------------�n---------------------------------- ;......... DATE--------- -------------------------------------------------- <br /> -4 ---------- <br /> BUJLbINGP`ERMIT ISSUED----I -------------a---------------------------------- ------------ -------------------- DATE---------------------•-------------------------------------­ <br /> AKirations­�tn�d/or recornrnendatiow�.."7�-----L�A_A---------------- - ----- --------- -------------------­-- --------A.................. . <br /> - ---------------- <br /> ------eirA--------_ry-------rry D-------- <br /> .......... ------ <br /> ------------------- -7---------- r�<-- ---- <br /> I <br /> ----------------------------------------------- -----------i-----------------------------------------­-------------------- <br /> --------------- ------------------- <br /> -- - ------------ -------------------------- ............. ----------------- <br /> ----- -------- ---------------­­------------- ----------------- ------- - ----- ---- ---- -- ---- -------- <br /> ---------------- ........ . ....... ...... ---------------- ----- --- ------ - - -- --------------------------------------------------------------------------------- ---------- ----------------- <br /> ................ <br /> AL INSP Date-----' W ..... ..... <br /> V$14 1,14 ZI <br /> ri SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 136 South American Street t 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-6iZ ATLAS <br />