|
4jOR OFFICE USE.
<br /> --------------------- ----------------------------------
<br /> ----------------- -------------------- ------------
<br /> ---------------------------------.`____:__'._"_______________________.___._____-- APPLICATION FOR SANITATION PERMIT Pertnit'No.'%_ !-C'.._3 2
<br /> ------- ... .,:.,,�.(Complete,in.Duplicate'�
<br /> D
<br /> Esc -�"°'`} -�� =- d�~4 TFtis Fermi#,Ex rtes 1 Year From,Date Issued Da Issued
<br /> Application is hereby made to the SonJoaquin�Local�Health District for a permit t onstruct and install the work herein described.
<br /> This application is made in compliance with County'ardinance' No. 549. "�� 22sq_.oeor 26
<br /> YESC/���( 77 � �)
<br /> JOB ADDRESS AND LOCATION-------------
<br /> -L�_ Flc1= r
<br /> -----o -----L o ,. --------
<br /> Owner's Name
<br /> e- ----•- UP�_x r_ _.... 1E5 _ � M�� Phone._TA-3 -2 1#4
<br /> ,� ## A
<br /> I Contractor's Name( '7E- _ --7:,1Q i•e
<br /> Address__-____t-OS. N. 1��"-
<br /> Installation will serve: Residence ❑ Ap�rtment House® .�ommer�CiaT, ❑ Trailer Cort ❑ Motel ❑ Other
<br /> ' -
<br /> : Number of living units: _ Numb r of bedroo"m`s '.._. �Number of baths -------- Lot',size -----y?-__�_.__•--.-
<br /> Water Supply: Public system ❑ CoB `ty1s stem ❑i F i ate Depth to Water Table ; e)_ ft.
<br /> Character of soil to a,depth of 3 feet: Sand ravel ❑ «Sandy Loam 0' Clay Loam:❑ Clay ❑ Adobe ❑,,.Hardpan,
<br /> :.
<br /> Previous Application Made: (If yes,date-,_.___..._,__.___.l No - New Construction: Yes jr__No ❑ FHA/VA: Yes ❑ 4o ,
<br /> TYPE,OF INSTALLA ON _AND_SPECIFICATIONS:
<br /> _
<br /> (No sept '�anko_r,cespool permitted if public sewer is available within 200 fee# �' ---�
<br /> � �
<br /> Septic Tank: Dstance from nearest well-,A10-------Distance from foundation:_. _.__,___.Materia#_�,Ec__=..�,+
<br /> N6., of compartments_z— --Size _ ?C-!4l_-5C.1Li ui w
<br /> ------- - - - q d "depth-----�� -
<br /> tAY I � 1 .4 �� � Capacity_ � ..
<br /> Disposal field: Distance from nearest:we!I..� --------Distance,from foundation. ©___'.__.Distance to nearest lot line-------
<br /> N
<br /> umber of lines__--_.1.5r_ __.--_ ,__ _Len tl of each line_P'�_. p.. v
<br /> g 3-- �_ Width of trench--------
<br /> -De
<br /> ----- --•-
<br /> �., Type of filter materiaebepthof.filter material �9�. __-Total lengfh_-______' � .z
<br /> I Seepage Pit: Distance to near well Linin materia(_-fes. oundation_____."v #___-
<br /> Distance to nearest lot
<br /> B`l�_i �_ Distance from
<br /> Number of pits-- �.--____-- g 6------Size: Diamefd___�_
<br /> I ty . "��,,[[ ``Jj Depth__..-j__------------------
<br /> Cesspool: Distance from nearest well____________ Distance'from foundation__-_--_-._.___ ._._.Lifiin ��'
<br /> ❑ Size: Diameter .. ma 49- ----------------------------------
<br /> i Depth-----+P1--.----------------------------------j'_.Liquid Capacity gals.
<br /> Privy: ____-_ ___Distance fromearest buildin
<br /> Distance from nearest well____________ _____________________
<br /> ❑ Distance to nearest lot line--------------------- ---•-- -I----- --------------------
<br /> ----
<br /> ,,. m
<br /> Remodeling and/or repairing (describe):_;: _-A. _y: ,
<br /> -----------------------• ---------
<br /> ------- - --- ------- I----------•------ -1-- ---------------------------•--------------•--------------------- --
<br /> - l ( r- ------•- • - --- -------------•---------------------------------------------
<br /> y P prepared
<br /> pP # 4 . ----
<br /> - 9.. cal ------------ ----------•--------------------------------------------------.:------
<br /> I herebycertify that I have re ared this a lice Eon and:fha+,the work will be done with San Joaquin County
<br /> ordinances, State laws, and rules and re ula+ions of the San Joa uim La Health District.
<br /> (Signed)--
<br /> 1
<br /> i ned £ tf
<br /> + r Contractor`
<br /> -------- Title}=- -�_
<br /> 4
<br /> f - j
<br /> (Plot plan, showing size of lot, location of system in tela_ on to wells, 6u!di s,•etc., can. 'placed on reverse side). 4
<br /> FOR DEPARTMENT USE ONLY I
<br /> APPLICATION ACCEPTED BY------_r-_ -__- - ---- """ ;- Z Z—'�
<br /> - DATE--------
<br /> ----- D
<br /> BUILDING PERMIT ISSUED-:- irt41 .__ 1 ham �! 4_I` lla p A7E. -
<br /> REVIEWED BY - -- ------------- --- ---------- ----------="---- ---- - ---- --- - ------------
<br /> -------------- �----------------- -
<br /> ATE----------- = -_ - `-
<br /> Alterations and/or recommendations:�C3Y�6.6 i� _ �jt/.._ L�} f�( v nj - .,
<br /> _=-- Afl>...._�o-t9.10.-- 0c�Tk�MJ----�'' ����r�_-'-"`�-�,�!� )-N4n&77!- )N49= ---
<br /> ------ A_�__._T--� -
<br /> R_ t ro--- w .++ Nom. ...............}?�?5 - . r1Q----- --�AA#D—, -.
<br /> ------------•---------------------------------- _ -- ----
<br /> -
<br /> ,.
<br /> ----------------
<br /> FINAL INSPECTiE3talr_.. _ .:...- _--k..-- ��. Date _ _�D W%4
<br /> a w+= .1 .3 1A Q „,�
<br /> ------------ --------------------
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> i~
<br /> I
<br /> 1601 E.Ha:elton.Ava. 300 West Oak Street j- , \ a I1.Sly:wl ��..i
<br /> 3 . 1'24 Sycom6r Street y 205 West 9tFi Street
<br /> Stockton,California Lodi, California Manteca,California Tracy,California
<br /> ES 9 REVISED 8.59 3M 3-'63 F.P.Ea.
<br />
|