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Pb <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .___ <br /> 4 -----------­-- <br /> (Complete in Duplicate) Date issued <br /> described. <br /> San Joaquin Local H.6alth District for a.permit to construct and install the work herein d <br /> Application is hereby made to the <br /> This application,is made in compliance with County Ord I�n,ance No. 549. -1 <br /> LOCATION-_ -- -------- ------- -------------------------------------------- ---------------------------------- <br /> JOB ADDRESS AND Phone (}4 ;2-2-- <br /> --------------------------- -------------------------------------- - <br /> Owners ---7.1 -- <br /> Own 's Name------- --------A-----13 <br /> -------------------- --------------- <br /> ---AE------------------ -tif­j-oet ------- <br /> V. --------------- <br /> ---------------- <br /> -60 - --------- --------- ..... Phone------ <br /> t - <br /> Contractor's Name-----------------------• --------------- Trailer Court [I Motel,D Other [I <br /> Residence- -tKA�artment Hous; .[-]F#Commerc;alj..E3j- <br /> 0-')"Number,of,baths --- ------------------- <br /> Installation will serve: e R <br /> Lot siz <br /> ng units: --- Number of bedrooms' <br /> )Depth <br /> Pr t to Water Number of iivi '@Lco,m6niity t-,i e r Table --- ft. <br /> Wa4er Supply: Public system m system] <br /> m M <br /> Grav'e*l 0 Sandy Loam El Clay Loam 0 Clay ❑ Adobe-A., Hardpan <br /> Character of soil to a depth of 3. feef:j.Sand [j <br /> 11 W ], No 123, New Construction. <br /> Yes Eg, No E] FHA/VA: Yes ❑ No [I <br /> Previous Application Made: Yes ❑E <br /> : <br /> TYPE OF INSTALLATION` SPECIFICATIONS <br /> ��IT <br /> (No septic tank or <br /> lk cesspool permitted if public sewer is-available within 200 feet.) <br /> t: <br /> �, ,3.......... <br /> ?4.,ilf!---Distancrom founclation-1-4-­---------Material- -------------- <br /> Septic Tank: 15Istance'from nearest well�? e f '6 depth--------y---------------Capacity-­-6--c�1--c----- <br /> No. of compartments­ <br /> t k�- 6-17 <br /> Distance to nearest lot lin�­�i <br /> Disp6�al FieJd: Distance from nearest well-e-e :!,&I�D4i�tance from foundation__ nciri -Z <br /> Nu <br /> . nbe'r'o'f' -lines ----kength 'of each line--------- 9-11,�-,--!��idth of tre ;-------- ----------- ---Z--------- - <br /> filter material___ ------Total length--,� oi -,T-------- <br /> Type of filter rn, e -----IDepth of to nearest r.t I k--" � r <br /> L <br /> nearest f o u n d a f 10 n <br /> a Distance o= j <br /> Seep,,6e" P;t:. Diametk?�J --------Depth---. <br /> aTe7i a I j2!e: <br /> �Iumber of pit --------Lming mi ...W-_ <br /> a -- -- --- <br /> Cesspool: Distance from' nearest well_______________ Disfan6e,from foundation------------------.1iningCa <br /> — '� : Diameter----------------------------- ---------wepfh- ----- ----�---- -------------------- -----Liquidpacity-__.________________.__x____gals <br /> I*r r . -( -. . <br /> n, �­!-!!,--------Distance from nearest building_____-------------------------- ----------- <br /> Priv D�sfance%frorn neeirest;well------------- <br /> Y. --------❑ -------------------- ------------- <br /> Distance t lot --------------------------------- ------------ <br /> ?a es <br /> T� . <br /> 4nd/or,repaii-,ing (describe).,�'. -------------- <br /> Remlin <br /> ------zi.eT fe-2 �Z <br /> -------C-;w -'a <br /> ............"- <br /> el:�f .. I --------------------------------- --------------------- <br /> I i V--------- i7 _-_--_r_ ._ 1;��-----------7------------ <br /> --------------I------- ------- ------------------ -----------------------------I-------------------- ------------ I I <br /> ------------------------ -----------------------\------------------------------------ <br /> -------------------------------------------------------------- <br /> ----------------------- will be don6 in accordance with S6r <br /> I hereby 4cef'tify that I have prepared this application and that the work <br /> ordinances, State laws, and r Health District. <br /> and rules and regulations of the San Joaquin.Lo�al <br /> ------ --------------i---------------------------- Own <br /> ------- <br /> er aL, <br /> V <br /> ----------- <br /> (Signed) <br /> --------------------- <br /> -------------- ------- -----------------------------Title <br /> ----------- <br /> By----- --------I....................... ------- --------- -------------- --- <br /> L <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e)placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ,-'-I-- -------------------- 4DATE--\------------- ------------- - ------------------- <br /> APPLICATION ACCEPTED BY ------------------ ------- <br /> iI-A i f'-{'I=- -------------------------- ---------------- <br /> REVIEWEDBY-------------- -------- ------------------------- P------ <br /> ------------------ ------------- <br /> -------------- 14 DATE-----AN------ <br /> BUIL T - [�-------- 1-I!-------- -- --------- <br /> DING PERMIT ISSUED------------- ------- ----- V <br /> 'T o --- - --- -------------------------------- -------------- ----- ----••------------------------------ <br /> ions d/or rec: .Dndali <br /> Alterations <br /> -- -------- <br /> ----------- <br /> A2 <br /> . ... ----- ------------- <br /> - ---------------------------------- <br /> --------------- <br /> ----------- ------- ------------------------------------- N4 L,% <br /> - --------------------n <br /> ---- ------------------------------ --------------------------------- <br /> - - --------------------------- <br /> �3t -------------- - -- ----------------r <br /> ---------- S-X <br /> - ---------------------------------------- ---------Date----------------------- <br /> FINAL-INSPECTION BY:,--r <br /> SAN JOAQUIN, LOCAL HEALTH,DdTRCCT <br /> - \ 4 " , 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street Tracy, California <br /> . I � Lodi, California Manteca. California <br /> Stockt*n,-,California V <br /> ES-9-2M • Reviseci 1-57 F.P.CO. <br />