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Perriit No,APPLICATION FOR SANITATION, PERMIT r
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<br /> (Complete in Dupkca#e) hate Issued ��f�l
<br /> Application"is,hereby made to the:Sots Jo'aq�uin-L,oc#1 Health District for.a permit to construct and install th rwotk,h-reio described:
<br /> This applicmtfod is made-in-ompliance with Courr-Ordinance-No. 549.,
<br /> JOB ADDRESS AND LOCATION_
<br /> Owner's Name-----=-IC41&11,_. T yC-U, !2_ a rrl,.•.. l✓ rC�O �E" Phone.,..................................
<br /> Address ........ Clf /�is / , fiy'
<br /> --------
<br /> .. _....
<br /> Contractor's Name------ 01.
<br /> k
<br /> Installation will serve Riki a j< Apartment House;[J -'Commercial .171 Trailer Court� []. Motel : Other Q
<br /> Number of liven aua�t = Number of bedrooms,, . Numbar�of baths .iX-- Lot size ---- ___-- _. ---
<br /> Water Supply: Pub
<br /> lic„systerre�[ Community system Q, Private .f epth`to Water Tak le,Z&.*ft;
<br /> Character of soil to a depth. 'F 3 feet: - Sand Q,. Gravel 0 Sandy,Loam Clay Loam'Or flay❑ .Adobe(� Hardpan❑
<br /> Previous Application,:�I�t4l mss- ry New Construction: Ytes , No E) FHA/VA: 'yes E] -No ❑
<br /> TYPE C'!1' ItSfALL1T �1
<br /> CA,
<br /> ..
<br /> INo.11eptia to nlc_ ce nnitted,f. sew is a a s 2W fest,)
<br /> _. __
<br /> Septi Tank: Distance from nearest well ,Distance from foundation__ ._:.Materia} %
<br /> sr ,J
<br /> r No, of c' �+rtments.__,_. Size �i�_. ' __._, u�d depth ___.,�►s ”'Capacity-_-,{C�d- �
<br /> �P� �� � � � -ter `� •-� r
<br /> Distance om nearest well ! Disio ce from foundat►on_. ,�, Distance to Abe
<br /> rest, line S^
<br /> Dispo I Field: r
<br /> Number lines 1
<br /> --•- , Len hof each has„--��$�!'_ �, Width:of trench
<br /> Type of filter material: e __._.Dep of filter materist,.s,, .........To4a1 length -1!r -- -- ,.........
<br /> Seepage Pit: Distance to nearest well ___.._ Di fanoe: from'-f ndation_.__::: Distance to nearest lot line_..:
<br /> Number of its z Size: Diameter...-
<br /> F1Depth.- _
<br /> P L�9 rr+aterial.. ...�.
<br /> Cesspool: Distance-from nearest wetl__..: 131sttlnce fram;fctndat+on_:_--- Lining tt(laterial .. ..:::. ......:..
<br /> [ Size; Diameter. ,� -Desh. P : .:Liquid Capeaety gots.
<br /> _.•... ..
<br /> Privy: Distance to*o _ Dice Ecom nearest bu�ld�ng
<br /> a wlrilk
<br /> (] alistance to nearesttot line-= = -
<br /> i
<br /> Re eli and/ �ing (des4rabe_): - - . -------------------
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<br /> -••--• --•-- �»-.�.,w.k., ...........................
<br /> .................---------------- ...........- ----. .......... t _.: ............. ------- --___
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<br /> I hereb certify thou - preparecuflik ' ' ll nand #h ti►ork will be lone in accordance with San Joaquin County
<br /> ordinances, State lawn Ufa nd � cif#� Joa;gtdin Local Health District,
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<br /> 31
<br /> �Si9n � ._ _ owner and/or Contractor]
<br /> RY --•- -:��= ,., ._._.. ..Tin - :
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<br /> (Plot plan, showing size of lot, location of"system !I' relatio we S. ur ncls eta„ can 6e p1ac `on reverse side).
<br /> �DEPARTMtNT USA ONLY
<br /> APPLICATION ACCEPTED BY- ---•---..................................-_._. ................ :_. bA -. .__._::�... .. _
<br /> REVIEWED BY --
<br /> •--•-- .•_._._ ,................................................ DATE
<br /> BUILDING PERMIT'tSSUED. _..,. _-
<br /> DATE
<br /> Alterations and/or.secornnendetions
<br /> ........ ........ ••----- ---.._.:. ..._.•-:., ,�_.::, ------
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<br /> FINAL INSPECTI{3Rl B •-- late-:-' '-'/fi"t/'� " ...................... ...................
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street 300 West Oak Streat 132 Syeamoro Street Si•#North,"C” Street
<br /> Stockton, California Lodi, Catifontie Manteca, Caiifor de Tracy, Celiiornia .
<br /> ES-4-2M i` Revised 1.57 F.RCO " '"
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