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1 13
<br /> AOR iOFFICE USE: Y
<br /> 3
<br /> No ................
<br /> Permit
<br /> Permit
<br /> 1APPLI ATIObk;FOR �aITATJO�'
<br /> ----- R , My
<br /> fi
<br /> ued
<br /> .�-�,f,----- ( plate ,w to
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<br /> This Kermit E ` ire ^� n.
<br /> r .r
<br /> _ - -
<br /> ° , eSCrl�bB
<br /> i�t.for a permit to Cogstru4t, •,
<br /> n is hereby made to the Son Joaquin Local Hea , f # ,
<br /> . :
<br /> tion is made in compliance with County Ordiri3lt a No 1 W. M
<br /> Phone~ ---
<br /> x � t
<br /> bJQ6,�IESS AND LOCA O 'f`�r
<br /> ----- -
<br /> -
<br /> --------
<br /> her.s Narimv__ ' — Y ----
<br /> c ......_ -
<br /> _ ------
<br /> Addres ��� ° ".`
<br /> 'Phommeraal ofpfh'�
<br /> Contractor's Name.:bLt - C ❑ Trailer Court ❑ "
<br /> Installation will server [( Apartment Houirl❑ of siZey,,- "'- ''='° .....`�'"-------------
<br /> Residence
<br /> Number bat
<br /> ,,b,„ w.
<br /> Number of,living.units: _ um er of`bedroom De o Wa# � ft. ' P :7A Y
<br /> ? ommprri system Q'i`r°�� Hardpan ❑
<br /> Water Supply: Pub4ic-systertr ❑ ❑ Clay Adobe❑
<br /> � � Sand Loam❑ Clay-.Loam Y ❑
<br /> Character of soil to a depth of 3 feet: �an �rahe ] y New Construction Yes,A,,No ❑ FHA/VA Yes E] No
<br /> ' iicafion'Madel: N
<br /> "(If yes,date
<br /> ,� _� �
<br /> oPre"ir,ouj Xpp
<br /> TYPE OF Ik41ALLATION-AND-SPECIEIC,PTIONS:
<br /> • er is available within 200 feet.) , -
<br /> (No4 septic tank,o�r*c�Spool..pe(mitted if public Av from foundation._feet.)
<br /> ---- 7te3ri�__�'�--"�;"��5
<br /> Distance from nearest well:_ Li Liquid
<br /> de thY�
<br /> Septic Tank: Size-%_1R__ ,K_(a_ ---t-- q � w�, `
<br /> No.-,of,c@►npartmt#�ts ----- r Distance to nearest lotline__.-_-------•---•
<br /> Disposal Field: Distance from nearest well `f'-Distance Irom foundbtion__� Width of trench--.__ `�� -"
<br /> -.'Ceti fh o each line.-I-7-9 ----- --------- 1' ... -
<br /> Number of lines__ - °' Total length-__- ,
<br /> _.De * of filter matetial___j� - ---------
<br /> T e of filter material__-R0-c--K p
<br /> YP
<br /> _
<br /> ._ Dista�ce from foundation__________________.Distance to nearest lot me__._____._.___.__
<br /> tr`3age Pit: Distance to nearest well ---- -
<br /> Number of pits ----.- Linin mat�ial---------------------Size: Diameter-----------------------.Depth--------------------------
<br /> Number
<br /> -----------------------i------
<br /> .. r : ., Linin material
<br /> '1.�►.►�'rd �> ......gals.
<br /> Cesspool Distance from nearest ell _ _R ___Distance from foundation :_._Li Liquid Capacity-------------
<br /> 1_ q
<br /> Size: Diameter._ �-`-': ----"-'-" ----Depth----- ----------------- -- -- -- -
<br /> ❑ Distance from neares,st building------------------------------------------
<br /> Distance
<br /> - -- --- ----- ----
<br /> Privy: Distance frnm-nearest well----------- y-- i
<br /> . ._ .. ----------------------------
<br /> Privy:
<br /> ----
<br /> ---
<br /> ❑ Distance to no lot line - - a
<br /> -*
<br /> -•---•.- -•-
<br /> .T t ��t-
<br /> --
<br /> Wemodeling and/dr repairing (describe):. --- - �
<br /> - ,� ti ,, -
<br /> ------------ - County
<br /> - th Jo d to C Y
<br /> --------- ------------ ------------------------•------ -- -- ---
<br /> -- a i S
<br /> I hereby certify that I have prepared this application and that the work will dgne:th �tca►rkl�rtoe "�' an a u•
<br /> Y rules rid r ulatio of a San Joaquin Local Health District.
<br /> ordipance3, State laws, (Owner and/or Contract
<br /> wn
<br /> O d/o or f
<br /> -- --
<br /> ' d -------------------- -- -- -- - ---------
<br /> (Signe ) Title
<br /> ---------------------- ---------------------------
<br /> -------------
<br /> By------------------------------------------------------------------
<br /> -----------•• buildings, etc., can be place on reverse
<br /> (Plot plan, showing size of lot, location of system in relation to wells,
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCENTED BY...- -"- -----
<br /> -------------------------------------------------- DATE-- I-----------------------
<br /> -----------------------------------
<br /> DATE--------------------------------------------
<br /> REVIEWED BY ------- Df'`
<br /> ---------------------------•------
<br /> -------- - ----
<br /> BUILDING PERMIT ISSUED --------------- -- •• -- -
<br /> -
<br /> Alterfions and/or recoryr/ynendatios � _ / __
<br /> .. --.---
<br /> r _ . -•
<br /> - i. ----
<br /> <: -
<br /> r
<br /> Date...
<br /> -----------
<br /> tl,A FI 4 1d;1PEGTION BY --- r-- ----
<br /> SAN JOAQ
<br /> UIN LOCAL HEALTH DISTRICT
<br /> 124 Sycamore Street 205 West 9Th Street
<br /> p th American Street 300 West Oak Street Tracy,California
<br /> Stockton,California
<br /> Lodi,California Manteca,California
<br /> ES-9 REVISED 8-59 F.F.CD,ZM 5.6o
<br />
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