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rvR urrlL.t ubt ..� <br /> ------------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..-�-�-h <br /> -------------------------------------------------- <br /> >- <br /> .. - - �� �. (Complete in Duplicate] <br /> -�``57` �t `' � - This permit Ex fires 1-Year From Date Issued Date Issued -__.....1_ /�7� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woos herein described. <br /> d. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_.11---- I <br /> j- C?lv �► <br /> ., .r � Q _. [ ry <br /> Tldlc:, c.. _ ------ <br /> ------- ----- = Ph <br /> one.:7:i�•l►.13A.t. t.4 . j:afn <br /> Address.---- .- - ®-x........ '_ n__... <br /> Contractor's Name _e ��---------------------------------------------• -•-- j' <br /> --- -•- --------- ........ Phone.------......------.............••. <br /> Installation will serve: Residence ®-impartment House ❑�Commercia E1 Trailer Cotn Motel ❑ Other ❑ <br /> Number of living units: _1____ Number of bedrooms - 1� ' <br /> t �__ Numberl�of�baths,� Lo�size _-�_.. � <br /> Water Supply: Public system E] Community system ❑ PrivateDepth to Water Table ZQ_ ft. I <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam <br /> I <br /> t - Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date___.----- ---"�"!�""'-r`1"rNo, SII. - m R — �F « ._ i <br /> New Construe#ion. Yes�No❑ FR ANA: Yes 0 No 23- ! <br /> TYPE: OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ifhpublic sewer is available';4;Ain 200leej.) <br /> Septic nk: Distance from nearest weN�__ 0____Distance from foundAibn°__�ar CoMaterial <br /> • <br /> No. of compartments_._.___..- -- Ir <br /> ----`.-Size_f'�__f..1Z-�-�-----Liquid depth___- <br /> / o. <br /> Disposal Field: Distance from nearest well_..-T-J� Distance from foundation....!_---------Distance to neareslot'�l'ne_....`.�...._..•, <br /> er Number of lines---� � " Length of eaWlinne '_`6' - •_ —0—f -re,41c. <br /> g - Width of +ranch.____._.-'� <br /> Type of filter matt riaL_ (- ._Depth of filte material____. ��;6--Total length------------- Q__.--_----_•-_ <br /> Seepage Pit: 1 Distance to nearest well----- --------------Distance fro foundation-------------------- <br /> Distance to nearest lot line._____-..______._ <br /> ❑ Number of pits----- ------------- Lining material------------I---------Size: Diameter-----------------------Depth-------------- <br /> Cesspool: Distance from nearest well_________________ ----_---------- <br /> .is an 4- fr fou%ndation-_____________..__..Lining material__._____...___ <br /> ❑ <br /> Size: Diameter = '� p _. Capacity <br /> -----•---...---•-----. <br /> - 1 ------.Depth ------------------------------Liquid Ca aci <br /> q �#�,, tY-----•------•...............gals. <br /> --- <br /> Privy: pistance to ne "la estrtwell --------------------------------- DlStanGe from nearest buildin <br /> Distance from <br /> 11 9 •----- <br /> arest fotg #r� --------------------------- --. s- <br /> ------------ <br /> Remodelingand/or repairing describe <br /> / P 9 ): __ l------ - �`} .-z—i� -•JAI--- <br /> 8VT4a- : - 1 .Qi. "�`. RSI <br /> � A�. :. ' T . -4- ---- -�-------- - C (_ I� '' 1 1__.._ C►_ `T <br /> > l�1 _ V - `I��_t�.4a. ""+a... ' = �-----------------------------------=--- <br /> ..... - - -----------------------•---------- <br /> ordinl hereby certify that I have pa pp .- n _ .. -------•---•------•-------•----------•---------•----------------------- <br /> =. N.-IA ----------------------------------- to-­^ <br /> Y p e-' red this a plication and that the work will•be done in accordance with San Joaquin County\ <br /> antes, State laws, and rule and re ui Ions of the SanJoaqutnTiocal;HeaItTDistrict. <br /> r-----(Signed)_ > f ' r- - •----- <br /> .� _ <br /> -- ;; ---------------•------- -----(ownet and/or Contractor) <br /> . T <br /> ey:.......................................------------ - ----- -- --- Title - <br /> - (Title) <br /> (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc.,_ <br /> tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED - -------•---- <br /> REVIEWED BY =------------- DAJE______-_---_.__••--_ ----- <br /> ------------------- ------------------------------ --- <br /> --------- ., <br /> i <br /> BUILDING PERMIT�I U-ED__ DATE_______--_------------------- ------- - ---- <br /> ]----•-•-•------------••------ -----------— <br /> and/or;recommendations:._- ----------------------- DA <br /> . <br /> • E <br /> - ------ _ <br /> _:I �- <br /> _..._._v. _ .- .� _JS <br /> `n <br /> .cy <br /> ----------- -------------- -------------------------- -----------------•- <br /> ---- - <br /> FINAL INSPECTION Date-------- '_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,California <br /> E8 9 REVISED e•89 YM 8-41 ATLAS � <br />