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....._............. . i I ' r,' L_ 0 I, f I V-L'. V I d's_ <br /> APPLICATiON FOR SANITAT60N PERMIT _ Permit No. .�.f2.�.�.,1 <br /> _2222. <br /> Complete in Dupficato A",3 -- 070'S� <br /> This Permit Expires I Year From Date 4asued Date Issued !4/} <br /> Application is hereby made to the San Joaquin Local Health District for 6 permit tc construct and install the work herein described. <br /> This application is meClasp compliance with County Ordinance No. 544. <br /> su!�I- I r, �/d0�nf3 tR <br /> JOB ADDRESS AND LOCATION......'r.... E - - 6 C .. .d—...... *0.17�.......�!d? :mss. .Ql .�., ........ <br /> Owner's Name...----- <br /> .�s----------------...-----. ._....-- ........._..................... <br /> . '..Kt. .. ..... <br /> Acidness......4.1, --I Box...... <br /> Contractor's Name._ -N ......�.FV1r.7 _L.._..�.E.�,y.f.•''r.C.M:.....s-------------- -- ----- <br /> �,; 22 _ +- ........... Phone.-.........-...............2222... <br /> 2nsfsllat6on will serer: Residenab ®Apartment House [I ❑Commercial ❑ {railer Court ` lNofal)❑ Other ❑ <br /> Number of living t ,./ire Number of bedrooms ._ Number f baths . . Lot size <br /> Water Su Publics Community y ❑ T <br /> ❑ Communi s stem Private Depth ro Water Ia a 2 ft. I <br /> Character a+ soil to a da $ere, <br /> $ ret: Send caravel ❑ Sandy Loam❑ Gey roam r,_I Gey ❑ Adobe❑ Hardper: ZI., <br /> '-eIOUs wppiiutias ,#Rade: (if Aes,date.... .___...-._.I No New Construction: Yes ja"No ❑ FHA/VA: Yesae _ No ❑ <br /> IF TYPE OF INSTALLATION AMD' SPECIFICATIONS: <br /> 1No septic tank or r 4 permitted if public sewer is available within 2200 fent.) <br /> Septic Tank: Distance f � nearest well...���....Dista a from foundation_r' .....--_Mat esi I._�r',7A4C.EA-F:1TZa,, <br /> L7 No. o4fill <br /> �s'r�ments_....�,........_Size.. .....-Capacity..-Er .©. <br /> . .2, <br /> Dispose) Field: Distanm . �._.,_,-f fouls tro -117......_Distance to nearest lot line... <br /> Nurn as........ .... .. .... Length of eac line4©.¢� ...........Width of trench.......�uy <br /> Type material...,MVCJ4�....Depth of filter material.....i.. . K d <br /> C I <br /> Total length..._.... $-__- S,-C <br /> Seepage Pit: Distance t4 earesf we1L.� ..........Distan a rom tounciation--... .--.._._ Is nce to nitarest lot line... 5-. <br /> Number oA ts.. Lining material-RO<K----Size: Diameter -t ...... Dipth......,g�ti _!......2........ <br /> Cesspool: Distance f o nearest well.................Distan a from foundtfibli'. p _-.._......._.-2222 <br /> ❑ Size: Dfkm* ...................._ -------....---Depth ............................YtW.. -�.. rtl Ca Capacity P ty---................._...gals. <br /> Privy: Disten�foo nearest well...._..._..__ .......... .---_----- ...._.Distance from nearest buildin <br /> ❑ listen ton rest lot line.... _ _ -__.._.-9- _------------------------------------- <br /> Remodeiing <br /> ..44126.1m—a.�.a.-+.'t-'.er n d ribs):... .-=a ----. ..----- -- ,...".-_..... ...... <br /> 4 <br /> - .-.-..' ...�' E S - .�a��r ' .�5'O ....0'a ..Fr.....�dF..... <br /> ac�4.....r? .__. fJ .......?? ...... df- u� -tt ......� 3k .. na -- 71.R, a...................... <br /> I "Iterebp certify that i have Prepared this application and that the work will be dons 4t accordance with San Joaquin County <br /> ordinances. State laws, and ruin and regulations of the San Joaquin Local HeaO. District. <br /> 4SnJned�----....-_�_ ?--- -- -------- -- .. . ... 2 22_2. ... and/or Contractor) <br /> B :. iidui c/. .. rn� <br /> ttr Y Fc"""g"� ..... - -. ._ITtilap... .- - <br /> Ip6ot pion, snowing ser of io fion of s item :n relation to wells, buiidings, are., car. 5e placed on reverse side)- <br /> FOR DEPARTivIEFET :_'SEONLY <br /> APPLiCA'rION ACCEPTED BX.-.- 77 E4z.� r -, <br /> pWED-.,, t <br /> AWLGING <br /> -...--------..-.. .......... . 2.2. ..RliT ISSUE . <br /> 2222... -......................... ........- ------.......... - 22hJ6aretiom rnalor .........-..___-.-.... .-....-...2.2.2.2..... <br /> ....-....-..- <br /> ... <br /> rrcommandafjpns:.... ... <br /> .....--...._...-._......_..................... .. _moi- ........ax..... <br /> �7--.-J��6F� - <br /> .......... .................2222.. . <br /> --------------------------- . .-...._..............._..._-....-...4......1..........-..­....-..- <br /> - - - <br /> . ... . . ...... ..... .'.?.Jh..;: �� ...2222 _2222.. _.. .. 2222. ------ <br /> J 2222 ... .. . 2! ... <br /> 2.2 2 ..2 . .. . . - .- [ - ._ . . .. ---- ._ ....._- <br /> FINAL INSPECT+QbL 8Y� .- 2222. . Date_ �o�a�. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 SWIM American shoot 300 Wert Oak inept 124 sycamore Street <br /> aos West vM sneer <br /> Brockton,California Loch,California Manlem, California <br /> Tracy,California <br /> ES 9 REVISED 5.54 2M 3-62 ATLAS <br />