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I%ai% %arrl�_L: U,)L: <br /> ----------------------- -------------------- <br /> ---------------- --------------­I...... -----------------_ FR _S1A4N.I <br /> — <br /> T TION�PL <br /> IT <br /> Permit No.------ <br /> ------------------------- <br /> ----------------- ------- --------- (Complete in Duplicate) <br /> -- -------------- This Permit Ex fres I Year From Date Issued Date Issued 1/2/_/­`��:t__" <br /> Application is hereby made to the;San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliancewith unt0 <br /> wit y in.8 a No. 349. <br /> JOB ADDRESS AVOCATION.-,- ------------- ----------------­ -------- <br /> ................ <br /> Owner's - .. -. <br /> ...... <br /> Name__.�( <br /> .. .... ........ <br /> ------- -----­--------­- <br /> ------- Phone......... -N <br /> Address .................... <br /> - - - ------------ ....... <br /> ------------ <br /> ...... ..................... <br /> Installation will serve: <br /> Contractor's Name.-- <br /> ---- --- ---------------------------------------------------------------------- Phoneo <br /> Residence ❑ Apartment House L] Commercial C1 Trail <br /> Number of living units: ." 7 Trailer` [I Mote] ❑ Other <br /> N bar of bedrooms -------- Number of 6aths3i . ----- �011�__14_ <br /> �e.00 t tse��e <br /> stem Water SU'PPIY..-Public-5 ­ 114"."CommunitY system D Private [I Depth to Water Table <br /> -- ------- ----- <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] <br /> Sandy Loam P__C_ray Loam E3 Clay [I Adobe 0 Hardpan 0 <br /> Previous Application Made: ilf.yes,date_--. _--------------) No New Construction: Yes ❑ No <br /> TYPE OF INSTALLATIONF—] El HA/VA: Yes ❑ No ❑ <br /> AND SPECIFICATIONS: <br /> [No P <br /> septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S c nk: 'Diista`nce'fi&on nearest well-----------------Distance from foundation-__--_- <br /> ' Materiel""..------- <br /> No. of'compartments--------------------------size-----------------------------_Liquid dep�h_ ----------••--------:................. <br /> ------------------------Capacity....................... <br /> s Distance from nearest well-----------------Distance from foundation..__._......""..."_-Distance...........Distance to nearest,lot,line <br /> Number of lines"...__-._ ............... <br /> trench".----_-----•------- r"" <br /> -_ <br /> Type,of-filfer�material-"._.--_-_--"- - ------------Depth of filter material--------- <br /> Length of each line------------------------------Width of trench <br /> --------------Total length.......I--------------------I <br /> .......... <br /> S. 11 <br /> Seepage Distance to nearest well-- D'stancefl—o)n fotclation./4 <br /> Di ance to nearest lot line <br /> 'i <br /> Number of pits Lining material_-__ Size:elation./ <br /> ----- ------- <br /> me r___ -----Depth----- ------------ <br /> j�,Cesspool: Distance from nearest well---------------- <br /> El 0-"�'ize: D'iameter'_:,-_ Distance from foundation--------------------Lining,mater;al--------------- ------- <br /> I Diameter;"_:-------------------•----- Depth <br /> ---•---------Liquid Capacity—----------------------_--g 6, <br /> s. <br /> Privy: t Distance from nearest well <br /> ❑ ­------------------------ -------Distance•from nearest building------------------------------------ <br /> Distance to nearest lot line----------- A' <br /> ­-------------------------------- -------------- ------------------------------------------------------------------------ <br /> 4 ...... <br /> f..Remodeling and/or repairing (describe):--------------------- <br /> -1--------------*-----------*-------------------- <br /> L—---------------_---------Zt-------------------------------------------------------------A 'L--------------------------------------------------------.......................... <br /> ----------------------------------------------- <br /> I ------------------ <br /> -----------------------------------------I----------------------- 2 IL .. ..... --- ........ <br /> ------------------------------------ I - ----------------------------------------I--------------------------------------------- <br /> ­--------------_------------- ---------------------t---------------- <br /> I hereby wfhalt I have prepared this application and that the work----------- ---------------------------------........ ........----------------------------- <br /> ;, , 5 and la ' i will 1 be done in accorda6ce with San Joaquin County <br /> ordinance I I d gulations of the San Joaquin Local Health District. <br /> -7 d <br /> Za es an e <br /> (Sign -------- -- .... .. <br /> ed) .. .. <br /> ------ ---- --------------- <br /> ------------------------------ --- <br /> er en Contractor) <br /> ------------------_--------- <br /> ----------- Ti <br /> (Plot plan, showing size buil ing .... .. ........ ..... . <br /> 4 ... . ......... <br /> Ize of lot, location of syte:m em to 51 ings, etc., can,be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPT 1p <br /> REVIEWED BY ------------------- ------------- <br /> ---------------------------- ----------- ------ -------------- -------- DATE------------ ----- <br /> BUILDING PERMIT ISSUED---------------------------I--------------------- ---------- ................................................ <br /> ---------------------------------—------*---------**---------------------4 DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-"-__"__"" 4­ 1 6 <br /> -------------------------------------------------------------------------1 1 V - I --------------------- -----------------------------------------------------------;...... <br /> ------------------*------------I---------------------------------- <br /> EI ..- ------------- <br /> ----------- -----------------------------------------------------------------1------------------It . i i -------------------------------------*-----------------*----------- <br /> .............................................................. k & ----------------------------------------------------------------------- ................... ---------------------------------- <br /> ------------- ----------------- I i <br /> ---------------------------- -------I-----------------------------­---------*--------------------------------*-------------------- <br /> --------------­--------- .......... -------------------------------- --------------------- <br /> ............................ ......I------------------------------------------------------------------- <br /> FINAL INSPECTION BY:. <br /> ------ -------------- Date--- -- •­ ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod],California Manteca,California Tracy,California <br /> ES 9 REVISED e-sq 2M 5-61 ATLAS <br />