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FOR OFFICE USE: <br /> -3-1 1 <br /> ................. rn <br /> ----------------------- ----------------------------- <br /> 4 APPLICATION FOR KANITATION PERMIT Permit No. <br /> -- ---- -- ---------------------- (Complete in Duplicate) <br /> -------------------- -------------------- i[ This Permit Expires I Year From Date Issued Date Issued ...... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance <br /> Mo. 549. <br /> JOB ADDRESS AN[�LOCATION..... <br /> - - ----------------------------------------------------------------------------------- <br /> Owner's Name. - jf�. <br /> ------------------------------------------------- ------------------------------------ ------ Phone.......................... <br /> Address-..----. . ......... . ............ <br /> ----------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name........ <br /> -WW ------------- Phone.................................. <br /> I It <br /> Installation will serve: Residence-5R'T,Apartment House E] Commercial [I Trailer Court IL],, Motel E] Other [_1 <br /> Number of livin units: Nu 4e`r'.',of bedrooms J"01- Number of baths __/__ Lot 9iie <br /> 9 !�� ly k -- ' ............................ ... <br /> C �; "`l�? k d <br /> Water Supply: Public system orritnuihity system [_1 Private [:] Depth TO Wat6r .T66le -- ft. <br /> Character of soil to a depth of-3 feet: Sand [:] Gravel E] Sandy Loam El Clay Loam 0 Clay [3 Adobe --rardpan C]"-LN I <br /> Previous Application Made: jiEyes,date___________________} No New Construcfj'on:"'Yes E] No U?- FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available-foundation________________ <br /> within'200 feet.) <br /> Septic Tank: Distance from nearest well_----------------Distance from foundation-------------------_Material-_____._____..__._-------------------------------x <br /> 4e4 No. of compartments-----_--I----------------Size----------../__ -----------Liquid depth--------------------------Ca aci ....................... <br /> � IF <br /> Disposal Field.: Distance fr1om nearest well____------_Distance,fr6m/ <br /> foundation....................Distance to nearest lot line......_._____._.. <br /> Number of: lines---------- Length'�f each line._249_-�------------Width of trench_,A_�,----------------- <br /> ept <br /> Type of filter material../ D h of filter maferial_.Af� __- length,;&----1)&!�__ <br /> Seepage Pit: Distance t nearest well_____`___-t-Ostance atiol-024-11---------Distance to nearest lot line..,.-$--------- <br /> Number of pits-------/-----------Liningmaterial._ <br /> ize: D ia mete r.N.?9'0/--------Depth_,A:0�7 <br /> Cesspool: Distance V1 om nearest well__________V <br /> -------------- <br /> . .......Distance from foundation----- --------------Lining material________________-_.__...________..._ <br /> Size: Diam`�- <br /> eter---------------------- --------------Depth----------------------------------------------------Liquid Capacity----------------------- ---gals. <br /> Privy: Distance from nearest -------------------------:------Distance from nearest building--------- <br /> --------------------------------- - <br /> El Distance to nearest lot line-------------- ----------- ---------------------------------I-------------------------------------------- ----------- <br /> 11 9 ----------------------- <br /> A <br /> Remodeling and/or repairing (describe):------------ <br /> ---------------------------------------------------------------------- <br /> ------------------------------------------------- ---I-----------------------------------------------------------------igr­-------------- <br /> 1 11 ---------*--------------------------1-*---------------------------- <br /> -------------------------------------------­­­ ---------------------------------------------------------------------------------------------------L-----------------------------------------------------------I------- <br /> ­­-----------------------------1---------:------- ------------------------------------------------I-------------------------------------------------- <br /> I hereby certify that.) he e prepared this application and that the work will be done,in accordance w I ith San Joaquin County- <br /> ordinances, State laws, and ru F 5 and regulations of the San Joaquin Local Health District. <br /> .lie(Signed)--- ---- -- -------- - --------- ------------------ - ------ - <br /> _--- <br /> By:------------------------------------I '- <br /> ---------------- ---------- ----------------------fQmna=md�w Contractor) <br /> By:------------------------------------ itle) <br /> - - - ----------- --- ---- --- ---------(T* ---------- <br /> ­ <br /> ---------------- <br /> (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED __t----_ --------------------------------------------------------— - DATE--- <br /> REVIEWEDBY-------------- ----- 11--------------- I--------------------------------------------------------------------------------- <br /> ---------------------------------------------------iI� <br /> DATE_................. <br /> BUILDING PERMIT ISSUED.......--------------------------------------------------------------------------------------------- DATE---------------------- <br /> -------------- <br /> Alterations and/or recommendations:..--.. -------••- <br /> __ �- - ----- - <br /> ------------------------------------------------------- <br /> ----- <br /> - <br /> -yn-64 - ------- --- -- ........ --------------- <br /> l.----------1-- - .. --------­-------- <br /> ------------------------------------------- ....... ----------------------- --- ------------------ ------------------------------------------------------- •--------•------._....------ ---------- ; ................ <br /> ----------------- --------------­------ --------------------------------------------------I--------------------------------------- -------------------- ------------------------ ------- ------------ <br /> FINAL INSPECTION BY:.... Date-----1/--- 2-- ------------------- <br /> --- ---- --"-Ze--- ----------- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT.1 <br /> 730 South American Street <br /> Stockton,California 300 West Oak Street/ 124 Sycamore Strest 205 West 91h Street <br /> Lodi,CaliforniaMantecaj,callfornia Tracy,California <br /> .ES 4 REVISED 6-59 2M 5-62 ATLAS <br />