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t � <br /> FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERM //'' AV--- -------- - ---------- --------------- --- - (Complete inDuplicate] Date Issued ---.�/,Z,�L <br /> '- Z'T_ S" -+-y4v✓P This Permit Expires 1 Year From Date Issued <br /> `----------------------- <br /> Application <br /> - _=----r f ----- `� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.d.NI <br /> This application is made in compliance with County Ordinance No. S49. <br /> .LOB ADDRESS AFDLOSID�CATION-.-.-..�_A- --_��'-�------ -�--- /--- i <br /> Owner's Name ; ! <br /> � r F------- ------ ---------------------------------------- Phone...................--•------•------ <br /> Address..............� `_ �.•- .. _ �i�_��'--�.�'.---------------------•---------------------...---------•-•----••-------------•-------•----- <br /> -f-----1---..8.0.4• Phone.._ :. '-/7-6 <br /> Contractors Name----- <br /> -------- -- <br /> Installation will serve: Residence Er-*�Apartme;n"House [3Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />` Number of living units: ........ Number of bedrooms : - Nu fiber of baths A--- Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private "epth To Water Table 00. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [� <br /> Previous Application Made: (if yes,date----- -----------) No New Construction: Yes�o ❑ FHA/VA: Yes B ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f / <br /> Septic nk: Distance from nearest well-_-S-5-40---- Dista c from foundation--- ____.___.Mater'al---------- �rr'.P 7 •-•----•---' <br /> No. of compartments-------�--'----------Size.�x_�•��`-_---Liquid depth--� <br /> Distance from foundation.--_.!1 _ t Distance to nearest lot line . - <br /> Dispos Field: Distance from nearest well-. - Q <br /> Number of lines--------�-------- ---------Length of each line--_ a .w, _:_- ---Width of(french----- ........... .------_---- y3 <br /> Type of filter material. �_ =--Dt pth f�f'rffier "er'�a1-..__i��------Total length------.. Qp-----------------•---- --- <br /> YP � ,, <br /> Seepa Pit: Distance to nearest well_ dl1---_----Dissttance�from foundatioq:,ZA_....sttavlmnc�e*to nearest lot line`Z-�_.__._ <br /> Number of pits-_,:. ------ g r �frbm found tion -.._ r.Depth----- ¢ G <br /> II_ Linin - D stark ��*Siz iamete. Lining material-----------------------•------.----•- <br /> Cesspool: Distance from nearest 4 gals. <br /> ❑ Size: Diametdr---------------- -------------------Depth-------------------------------------------------- Liquid Capacity 9 ? <br /> 17,,, <br /> `r"r y `------'-----Distance from nearest building-------------------------------•----• <br /> Privy: Distance fro nearest well _._------------------ - j <br /> ❑ Distance tonarest lot life------------------_--- <br /> --------•-------- <br /> --------------------- <br /> rwI Remodeling and/or repairing describe): -•--------------- ----• ----------------------•--------------•------..-------. <br /> -----------------t�'_fi=r-------ll U -- T•`• <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, and rules and regulations of the San Joaquin Local Health District. <br /> ------ •---- � ;;( <br /> Qvner and/or Contractor)(Signed)•----t••------ <br /> - <br /> - s butEdin s e+c. can bele a d�n=re •� ' <br /> (Plot plan, showing ki a of lot #Ian of sys+em to relation to well , g , p verse side]. <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Y - i ---`------------- ----------- DATE .. d�`l <br /> - ------------------- <br /> REVIEWED BY-------------'----------------••--------.._.-..--------'----•------------ ------------- ----------------------- <br /> -----•------- DATE-----------•-•-•-----•-•----- •-----------•--------------- <br /> BUILDING- <br /> ------- <br /> BUILDING-PERMIT"ISSUED .. ------- <br /> " <br /> Alterations and/or recommendations: <br /> - •• 4 <br /> lP - . <br /> � <br /> ----- <br /> ­­----------------- --------------- <br /> FINAL INSP ON BY _ ___ ---- ------ ---- -- <br /> Date L.-- <br /> " ANN JOA QUIN LOCAL HEALTH DISTRICT <br /> 3001Ari�f Oak.Sr eat 124 Sycamore Street 205 West 9th Street <br /> 130 South American street 1 M �y} <br /> Stockton,CclifoTha Lodi,California Manteca,California Stacy,California <br /> r ES 9 REVISED 8-59 2M 5-62iATLAS �� <br />