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rVKurrit-c uac Z Ut(i <br /> ip y\ <br /> AWtICATION FOR SANITATION PER-.,o4Permit No. . <br /> - (Complete in Duplicate( -35 / <br /> �� ..07 0- Date Issued ._��.. �.......-� <br /> --._................_--.._--_-..-_-_._-..-_._.. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San 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 No. 549. M9ANMECA - <br /> JOB ADDRESS AND LOCATION...../ V!-5 AC--------_E�----_QE------ -/4GK.1-QnI-fc,_,._,___.•__ s <br /> 1 L-�. �. ' - - - - - -------- Phone.--�........ 7�--Add1 <br /> OOwner's-Name.. . --....._ 6'1.-- <br /> -. ( AX-------15Y--------81-PO-N.'------- .------------.---------------------------------------------------- <br /> Contractor's <br /> -------- -----Contractor's Name.AIANT SLA..--...5W!Xf-L---- lZ11.1-C -....=tF:r-------- ----- ..`.............. Phone...-------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ �raniler Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -.'..._ Number of bedrooms 3- Number f baths -h Lot size ..- - A F -...._-..___ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ZZ ft. <br /> Character of soil to a depth of 3 feet: Sand 93�-Grevel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date........__---- ) No New Construction: Yes jo"IlNo ❑ FHA/VA: YesA7r No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---,S----- ...-Dista ce from foundatlon.4-0-..-------MateVi I_.CQ-NCR. -..--. <br /> No. of compartments..... ___......Size_ X/O.X -��...._Liquid depih_... --- Ca aci <br /> 2'O-Q-- <br /> Disposal Field: Distance from nearest well..-0,.------Distance from found2j.iOr9----- .Q........Distance to nearest lot line.. ........... <br /> i n <br /> g- Number of lines- - -. ._ - ----- of each Iine,$Q-- -H.-.-..Width of trench------�y--_- <br /> Type of filter material_.?004.....Depth of filter material....-/�.-...__.Total length-----__�611�-...�.. - <br /> /� r (__ <br /> Seepage Pit: Distance to nearest well--/"0---------Distance from foundation_..��- nc'eo n?arast lot line_.IRK I�.�.. <br /> Number of Lining ma+erial- OCK _.Size: Dia Star X.___-D +h---_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_ _--------------Lining materi6l--------_..---.-.-.-.------.--.-._- <br /> ❑ Size: Diameter....----------------------------------Depth ......---------------------------------`------....Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------------------.-----Distance from nearest building.j...-__._....................................... <br /> ❑ Distance to nearest lot line. -- ----------------- ----------- ...........1 --------------------------------------_ <br /> Remodeling a�S re airin4 de tribe):---I/P Q1(-----g.-_------F----1 AR�M:A�- ft'�-----3k--------T..-- lr� .----- <br /> t?tr1._'! � C1iI5-..... T-------$.11-------r------401A --��-------SL),155 � �'[.� ��fi� -`�� - <br /> .Q F------LEOC t>�-. -41.N. r '-------------SP,I�--...J (Cts D b -�So----fig✓-...F'►.'....OF. . <br /> ROCK-----A ---jL��3------4FTIER------RUnrMA16n...Intl, ------HAMPAN------------ -RO-Ac-------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ----- . .. .-_. -- -- - - ----- .. . . - . ----- (Owner and/or Contractor) <br /> By: _._.(Title) <br /> ---- ------- -- - r .atr�f - ------ - --- _.. _. . _. <br /> (Plot plan, showing size of I ca 'onof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> -�- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCrF,PTED BY----- 1.-•. `Q - -- - ----- - -- ...._........... f►TE_:_- 0-':- .:F,. ��. <br /> REVIEWfD-BY-:t ..:- -_..- .. - - .. ...... --- DATE---- - ------ - - ._.. <br /> BUILDING PERMIT ISSUED----------------------------------------- ----- - -- . ......... DATE----- ---------------------------------------------- <br /> Alterations and/or recommendafons:------- ---- -- -----------------------------...... ......................................_...... ......------............... <br /> - <br /> ------------------------------------- ------1��� ---------C1Al-S------- a.-- -SAN-,D............. - ----------------------........... ----------------------- <br /> .__........... ..... _---- --------- - --------- - - ---- -- ---....... - -- ----------- ------------------- <br /> -. -� .. .- -. ......................... ---- . . - <br /> ... . ... ... .. . .. . . - - - - -.. .. .-------... .. . <br /> PE�T}(Ze - � � vG'-moi Date-_ /K.. <br /> FINAL INS <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strout 300 Wut Oak S,reet 124 Sycamore Strnt 205 Wast 9th Sireot <br /> Stockton, California Lodl, California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />