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"1 APPLICATION FOR, SANITATION PERMIT i. Permit No. <br />/�'] r� (Complefe in Duplicate) <br />!l/V .. _ , _ ,_._ Date Issued <br />XED <br />Application is here6y•-made to�the SanJoaquin'Local~Health"District for a permit to corisfruct and instal he ork,herein'descrilaed. <br />This application is�made in compliance:wifh County Ordinance No, 549. a . <br />,' _ !`- <br />i JOB ADDRESS AND LOCATION. -��----_ ---c d%--7 iL;�_ :: f=>� r t <br />Owner's Name r$� _------------- <br />----------------------------h ae <br />.. <br />n <br />C Addr ti P # <br />ass -------- -•--------^ <br />.. .i�id'.... _.._ <br />1 � .• Contractors Name----=-----------•-----•- ��'•-�--�----•----- � ` <br />Phone AVO:— 1 <br />Installation will serve: i ResidenceER"-Apartment House Commercial <br />r 5. ❑ ❑ Trailer 'Court ❑ ' Motel- Other ❑,. t.Y <br />I Number of living units mber of bedrooms -Number of baths 'ILot-siza '.. �. -- <br />Wafer <br />a - <br />Wafer Supply;` Public system" . Community system❑ `Private.❑ bepth-to Wa}er Table 9„5ft.''-' .'"*'., <br />� 5a <br />Character of'soil to a depth of 3 feet:- Sand ❑ G'ravR I❑ Sandy Loa ❑ .iClay_L.oam E]Clay [] ' Adobe Hardpan ❑ <br />Previous Application Made:- Yes ❑ No,Eg-.-Tlew Construction: Yes No -µs <br />TYPE OF INSTALLATION AND SPECIFICATIONS:„ t <br />(No septic tank or cesspool permitted if public se' wer is'available wifhin 200 feet.)44::_ _ j ► i <br />Septic Tank: {Distance from nearest welf--------- -------- Distance - <br />from foundation ---------------------Material <br />Jam' <br />1 <br />of compartments ----------------- Size = Liquid depth - -- ----Capacity <br />Disposal Field:. Di ance-from nearest well...." _----- . Distance from foundation ------------- ____.D�sfance to nearest:lot line -------- ------- a <br />❑ of. lines_ ------- ------- ---------- ------ Length of each line------ •_ - -:-- ` -- Width of trench -- <br />Type- t <br />TYPe.bf filter material---.._ .--..._- <br />--=- �------- <br /># Depth of filter material � _# -__- ------ Total length -------------- y <br />See .a a Pim Distance 'to nearest well.. -Distance -from foundation.... _ Distance to nlip <br />earest lot ime"_'7,,_9.�.. <br />Number of its- : i._..:.' --Lining materiaL.;Y. c?-� -k'--'Sizei Diameter ._ _J-11 ------- Depth __._�,------------- <br />Cesspool: <br />l _- _--- -- <br />Cess ool: Distance from i <br />P neares#'well _- -_ Distance from foundation .. .Linin material -...._ <br />Lin -Ing = --- <br />❑' " Size: Diameter:.. _.Depth :-Liquid Ca p acit <br />Privy: Distance from nearest well " ...^" ' <br />_ . Distance from nearest building <br />❑ Distance to nearest lot lire ','-::`----� ... .' <br />Remodelin and/or ��65•� _ _ � 1 - •" - <br />g / <br />or re airin�--- ---- -�-'- -p rsi �.� ---- <br />-- ._______....._ . <br />_i - <br />- <br />... .... . ......."-.__._..- <br />------------------------------------ _ _ _ f - <br />I hereby certify that I have -prepared this' application" and ' that the work will be done in accordance wifh San Joaquin' County <br />ordinances, State laws rrd rul and r s' of f e San Joaquin Local Health District. <br />......... <br />'- �' S e <br />// f x <br />- - - ------ -- <br />(, g er and/or Contractor) <br />BY _ <br />/�fes/�[Own <br />�' <br />(Plot Ian, showin s . " <br />p g s' of lot, loc tiara of sysfem in re afion fo wells, bui mgs; a#c„ can be placed on reverse side). <br />DEPARTMENT=USE'ONLY. <br />APPLICATION 'ACCEPTED BY_- --------- _-._.DA�149�74 s - ----=---------- <br />REVIEWED BY ----------------------------- ', DAT:=---------------------------------- <br />­ <br />sF, <br />BUILDING PERMIT�ISSUED---- -;_ p ' L --------------- - <br />---- <br />AItions and or ecommendations - <br />n' <br />------ - . ---------- - - - -- ----- <br />V T --- -------- -- ----------- ----------- -------------------•---- -- - .._-• -- - <br />1 4 -_.. <br />.. ....r ...._-__ <br />---------,"------------------- i ---- - ------• <br />..:— ---------------- <br />a---------- - ----- -------- ----------` <br />',T � <br />FINAL INSPECTION BY: _� , �j;(�jj-�--Date.: �-. .�V <br />SAN JOAQUIN LOCAL HEALTH DISTRICT I <br />130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" St:eet <br />Stockton, California Lodi, California Manteca, California <br />Tracy, California <br />ES -9-2M Reviser! 1.57 F.P.CO. <br />