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FOR OFFICE LJSE. <br /> ---------- ----------- ----- ------- ------------ <br /> Permit APPLICATION FOR SANITATION PERMIT t No. _/s..24V <br /> - <br />.............. ------- ------------------------------- (Complete in Duplicate) Date Issued ......��/10 <br /> ----------------------------------- <br /> ­------1_ ......... I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for i permit to construct and Install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. T 4a <br /> JOB ADDRESS D LOCATION........... -- ------- -------------------- ... . 4 (,_ �lt,•r-------C.L1-----...... Eck/- <br /> Owner's Name..._ ------------------------- <br /> ............................. <br /> Address.........k2-.. - <br /> .4 :��.......... <br /> ------------------ -------------- ................................................................................................ <br /> Contractor's Name 41 <br /> _1-------- ----- ...�96 ----------------_--..................... Phonek._�" _-,ti <br /> Installation will serve: Residence Er"Aparfmenf-Hase P Commercial El Trailer Court El Motel 0 Other (3 <br /> Number of living units: Number,of.bedroo4_0 Number of baths_2�,LoAsize .___..:61 <br /> xI - ­/.............................................. <br /> Water Supply: Public system. ❑ Community system El Private Depth TO Water Table -9-4?ft. <br /> Character of soil to a depth of 3 feet: i Sand 0 Gravel [] Sandy Loam 13` Clay Loam 0 Clay [3 -Adobe 0 Hardpan C1 <br /> Previous Application Made: (If yes, NoEr-Ne.w,Qonstruction:_Yp ,Er'-No [] FHA/VA- Yeso No <br /> TYPE OF INSTALLATION AND''SPECIFICATIONS: <br /> (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) <br /> Septic T k: Distance from'nearest well------- Distance from foundation---------- --------Material------------------------------------------ <br /> th <br /> No. of comparfm�n ------- Bance <br /> -----------Liquid de p- --------------------------Capacity------------------------ <br /> ---------- ------- <br /> .........1� 0 <br /> Disposal Deld: Distance frorn;nearest well-----------------�Distance from foundation.............!-....Distance to nearest lot line....._...._...... <br /> Number of line,-'$.......Y------------- --------Length of each line........................!-....Width of trench........................._......... <br /> Type of filter ma4e-riai_----------------------bepth-of filter-material-------------.......Total length------------------------------------------ <br /> 46 <br /> Seepage Pit: Distance to nearest,well.-A---------------Distance from foundation....i:o�_-_'xtistance 10 to nearest lot line-O./ <br /> 16 Number of pits--------- -------------Lining material---- 4� • <br /> -----Size: Diameter--_ ----gFp <br /> th-------- ...... <br /> Cesspool: Distance from near'esf well-----------------Distance from foundation--------------------Lining material-_.___________-______________________ <br /> Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance-from-nearest•well__ -___ __________________..___._._-.__._Distance from nearest building__-___-.._________--___---____.___...... <br /> ❑ <br /> uilling----- ----------------------- <br /> Cl Diifance to nearest ]of line---- ---------------------------------------I---------------------------------------------------------- <br /> Remodeling and/or repairing (describe):___.____-- ------ ...... ..... <br /> -----------------i --------------------- ............. . <br /> ---•----------x-,-------- --f--------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- <br /> ---------------------- ------ ---- ----------------------------------------;--------------- <br /> J-------------------- I—...*------------------------------I^--I---------------*---------*-------- .........*------------ -------- <br /> ------------------------------------ --------------------------------- -------- -------------------------------------------------------------------------------------------- -------------I------ <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 /> id) -- ---------(S' ...... - ------ ------------ -- -1----------------------------------------------- ------ _4�_ --------------------------- and/or Contractor) <br /> kAJ kkkkOL-,,_, <br /> By:.......... - A ----- ----------------------------- -------------------------------------------------------------------------trifle ------------------------- <br /> (Plat plan, showing siz4o-lot,location:-of,syrtern-rin-relation to wells, buildings, etc., can be placed on; reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY' <br /> ------------ _1(jee------------_7-------------------------------------------- DATE-----........ ----------_----- <br /> REVIEWEb'BY--------------------------------------- ---------------------------------------------------------------------1-------------- DATE----------------------------------------.................... <br /> BUILDING-PERMIT ISSUED-------------------------------------------- ----------------------------------------- -------------- DATE-------------------------------------------------------------- <br /> Alteratiops and/gr re ornmen ...... ........ ......­­.............................. .......... <br /> c _$afions:----------------------------------------------- <br /> Y---------------- <br /> -------------i��r I <br /> ----------I------------ ------ _c-------- ---------------------------------------------------------------- --------------- <br /> ------------------------------------ ----­­---------------------------------------- ----------------------------------------------------•---------------•------------•--------------••------ --------._........----•-------- <br /> ------- <br /> -----I........I--------------- <br /> -------- -- --------------------------------------------------------------------------------------I-----------------------------------------------------------------------------------­­-------- <br /> FINAL INSPECTION BY:. Date---------------- --------------------------- ------- <br /> ------ ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300-West Oak Street 5 124 Sycamore Street, 205 West 914 Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 859 2M 5-62 ATLAS <br />