|
APPLICATION FOR SANITATION PERMIT Permit No. -----
<br /> Com !
<br /> f '
<br /> [ p e+e in Duplicate)
<br /> ate Issued / _
<br /> � :._!
<br /> App Ica}lora r`s�hereby made to-the San Joaquin Local Health'DisfTicf for a erm_ tr#o construct andiinstall+he.work'herein`described.
<br /> This apphtaition ai�made rn compliance with-County-Ordinance .Not T - --- F. I _ 1
<br /> }._ _`t
<br /> JBBADDRESS AND LOC TION = ��f ._._ �-+ a *--'-=-----_-- ?_.____-----
<br /> -s#Nsmer_t-----.- � + t �P q . 3
<br /> . r: h ---------
<br /> = one
<br /> : � ,
<br /> Address T.,... �L-'� �7�f' -�' a E -f I 1 F ! �-� - j ,
<br /> c r , I
<br /> -
<br /> Contlractor s�Name,_ I r1-I I � � �-- i--:_ I � -- ---f - i Phone-------------------------------------
<br /> fillr
<br /> I !-�� I '_.i 'i -r -I-"`� 1 -�� � �'i_' �� 1-1- ! '-❑1 .I
<br /> Insta�latron will served Residence � Apartment H}ouse ❑ Gommercl7jal l r Trailer•Court, ] -Motel Other ❑
<br /> bor of Win units t -Number of bedroomst-Z/ Number of baths t 7l of size
<br /> g 1 Y' ---------------•- --------- r
<br /> I f �
<br /> Wafettr $u ply I1I Publie sy tem❑ "Coiiiim�m�u�n{ty y bh'10 *`1 ate6 DEepfh tO W-a�e+Ta ble 7_7.ft'-4-f---
<br /> 4
<br /> h '1 •4.� {_i. I t I. I }.. . i �. I ..�.+ 1-! i j I I i i
<br /> Charaster,of sorll.to;a dep#h�af 31fee+ , Sand:❑, Gravel''I❑c ,'SandlyiLobm ❑.Clay Laam a❑. Clay;❑ Adokie Hardpan ❑
<br /> { - } ! 1 j { t tr}uctlon Yes I iNo
<br /> Previous Application Made: Yes ❑ No } New,Cons ❑
<br /> 11 , #,, } 1 i I i
<br /> TYPE! OF INSTAL TlOWAD"SPECIFiCATlONS i -f a I I I f i - ] i § ,
<br /> t-1. .i I - 4 - .}. ,
<br /> }[ rmittif public sewer is a� m foin 204 feet t ; -
<br /> No septic tank or cesspool p�e variable with
<br /> Y` >
<br /> Septic'Tank s'�-I -Dis#ancelfrom nearest well D f ' dation� _I �I_Ma'terial __________ _____________
<br /> h + rk' I 1 j 1 , rs��lc� r r I i �
<br /> ❑ ` 'f{ p I j [ ize = { - F Liquid 3depfh j---I } r I I Capacit -------------------------
<br /> +
<br /> i
<br /> No!.of corn arfinents_ _ S
<br /> Dls ost [J { , ! 1 ut: n j j.ti j I d n
<br /> p Numk�e`r of Imes_ I r ; : , 1 , o nda ton, _' Distance to Barest;lotiline____ ___________
<br /> al Field:{-- -tsbrstancefo'mF neaesflwell *+~' 1 Lengthlof e ch� }.................1r ' fi 1 1
<br /> ®`171_ I I i. ' _.?� :De th of filter Ylnaterllal ' j Total hlength'----------------------------------------
<br /> 0
<br /> ch ''= = - t
<br /> --------
<br /> Seepage - �STath7 i .1 I I i
<br /> f" } N
<br /> T e of filtertmaterial.:
<br /> «l s
<br /> �istanteta neares' we I Distance,fro founda+ion ___.Distance to: neare st'!ot line__: _
<br /> ' � I
<br /> ' P k ,
<br /> Number hof i .�s:. ._ v t 1 `"Linin -naferlal-1--� - -' _�• ; I I � �...} - � { I
<br /> -. ice Diameter ;depth---
<br /> Cesspool ; ; ;Distance fiom nearesf;,well ,� __D stance from,:folndation ____ _ Lming materia ._. ___._____ _.
<br /> r
<br /> ! Sizer Diameter _
<br /> ]"'.•.1_.r r 1.T. , , X r� : - Depth r r qu dt apa fy------------------, •-- g Is.
<br /> LI i C aa
<br /> r f I I I I #
<br /> Priv +' '1 t Distance from nearest w£1! _!.'r w I ' t 1 j D I-
<br /> . ,! 1�fatiCe r m n
<br /> ❑� , a I r e`to�nearesf'1of 11n�et -1" ar 9_ i ---- --------- j
<br /> ne j p {. -
<br /> �, { i.,� 1_ { i t ft , � � t1k (_ � ] i V
<br /> Re ng, aJ.
<br /> ril%arpairng {describe] s_ � f 1 + 7� I ' I i { 11 �l•_� i i i #
<br /> g -t ; f rt t i - r i jun 1 I 1 I } k J f iW - -' r ! +-i ' F � ' -I- k + i ' '
<br /> -
<br /> �} { { { • -__� T ! !''_ 1 --, ---�- -..I-� .. .-.. }. �,. .,r_ {------- - - t 1-1-1 4—�� �i _�•• __ .__ _____'___1 ___ __ _ __ _ __._ . _ _ .. � i � r tT e :. 7 { � t:"�. {'�-1 I-� -I i i T_. fI Fhereby;-ceetify`that I"i~iave prepared'-this-applrestloriand th' +f4fie-work w'rlllbe done in accordance with San Joaquinordiriences,'Staf, law 'a`nd rules and reg61ations of the San Joaquin Local"Health Drs+nc+`.iE 777i.[Signed] + fi i rt I I i t er an / r CoI I �. „f, _. _T. r r1- - I L+ Ek' I [� n. � a -_. - i1 - f k ! ---- 1 I .L - a-- 9i s...__... - 1e i --I,-; $ a i- ' -l- ti- i w ' -5-.F- '- r 1_L- { �- +-.f- f- i .,. i .{Plot,plan,showrng:srzefof..lot, Iocation of,.systam,iri relation to'weNso burldrngs,_etc,.can be-placed on reverse side).
<br /> r - -
<br /> -S ' . FOR;-DEPARTJvIENT:LISE ONL*Y-t 1✓'.
<br /> -%-,3.-.{..f.} .-t L_.
<br /> r'rPPI KATION ACCEPTED BY I y i 1 r T 'DATE t i r
<br /> REVi�WIED•BYf4 �" t t [ I I t . I T ,DATE { _if�
<br /> BlJILD]'NG PERMIT ISSUED _ � rt { I -I + ] s�- r �
<br /> Alteretrons and/-or'recommendafions: � ` �` � I t , , 1 .____..�-------------•--------- ----------------_----
<br /> [ { 1 d I ] I- r r-' -i-- t • 1-
<br /> } y i-i- f.. , r. _I._. _y .� {_I ..-3 + F _--------------------{ r I I - $ t, S__
<br /> - ='- i { 1 * *_t t t -.-- - Y--i' ----- -- t + A
<br /> 1-. a +• I_,.•-t-.-rot.--..i- }. �1----,..1 1 - - •-'`�--i- r : -. - -I --------------------------------i---------- -
<br /> ._._.__ _i a_
<br /> L i
<br /> i 'r i..• r +-� J 18 1- ."•-, ' , 'i , i i !_ t I - f
<br /> .-'i-.-I �.f. 1 {1 _ _L 1- 4-J- } Y I ^ __•.-_-------------------
<br /> q
<br /> _' I I - i I .{..
<br /> FINAL WSPECTION"BY .t- --- -1---------------------------- .._-. ---- ��ate -I�' �Dti - =' --------------------------------
<br /> -C
<br /> �' -'"
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street
<br /> Stockton, California Lodi, California Manteca, California Tracy, California
<br /> E5-9-21M 145446 ATWQCD 12-54
<br /> n
<br />
|