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FORUSE:OF <br /> ......... .................. CATION FOR SA14TATION PERMIT- Permit No. <br /> .................. ............................... (Complete in Duplicate) Date Issued <br /> ........................................... ... This Permit Expires I Year From 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 compliaitbe with County O�rdina..nceNo. 11. <br /> JOB ADDRESS AND�PC IONJA�_�9# --- - -- - - - -------- W_-_ ................... <br /> Owner's Name.--- WAK .72r?, .. ............­.......................................................................... Phone.........._...----.___ <br /> Address_._ � '­_i------ --------- ;:....................--—------------------------------------ <br /> Contractor's Nems........_..._.%*_*,_k­*a_=4AWA�XiZ......... <br /> .1...........­.................f............................ Phone..........._....... ........ <br /> Installation will same: Residence [I Apartment House 0 Commercial 0 Trailer Court Er__M�ohsl 0 Other [3 <br /> Number of living units: J_ Number of bedrooms.1t.. Number of baths Z--- Lot size ...4?jrk�............................. <br /> Water Supply: Public.systern 0 Community system'O Private "Pth To Water Table _:PrAf. <br /> Character of soil to a depth of 3 fa!rIn Sand 0 Gravel 0 Sandy Loom 0 Clay Loam 0 Clay 0 Adobe[A,'gardpan 0 <br /> Previous Application Made: (if ye;!dote_..................I No Gg"New Construction: Yes [VIVo El FHA/VA:Yes 0 No R' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool �ormiffed if public sewer% -y¢-available within 200 feet.) <br /> Septic Tank: Distance from•49arest weilRA7.Distce tom foundation....!!=......M,,.,i,L&.e__,s �e.4�;........... <br /> �3o�, t....__ , ------ 19­...Liquid depth--- capacity...r. f compartnenfs--- x........ Size ---x <br /> Disposal Field: Distance from nearest well./40.ir6istance from foundatiqU... ........Distance to nearest lot line..ift-.'.... <br /> Number of lines........../...... 7,'Length of each lin.......Y49._.............Width of french... <br /> Type of filter materiaI.,UXji;e Depth of filter material.../j Total length....,00. <br /> ............... <br /> Number of pits!1_1.............Lining I?Afk*.'._Size: 6annatier. ............Depth... ..... <br /> Seepage Pit: Distance to nearest well...../_,oQV.."Distance fr m foundation Dist a to nearest t lim, <br /> up/ me 14F............... <br /> Cesspool: Distance from"nearest well.................Distance from foundation.....--.............Lining materiel......................._.........-_ <br /> Size; Diameter!................------------......De th...................................................Liquid Capacity.-.....................gals. <br /> I <br /> Privy: Distance from nearest well.................................................Distance from nearest building....... ....................... <br /> ❑ Distance,to no.61rest lot line................................................. ... -------------........_---•--......----................... <br /> ...... ............................................. <br /> Remodeling and/or repairing Ideiribe):............ --- ------------ <br /> ....... ................. <br /> . .............. . . ..... -------------------------------------- <br /> ...... -- ---------------- ii�w <br /> .- -;4.AA---- I - - - ------------------------------- <br /> ..................................-------------------------*..................... ...... . ........................................ ­....._.­....................... <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 pies and regulations of the San Joaquin Local Health District. <br /> (Signed).-_......_.... ~-. ........ ----- Ccoittractor) <br /> Br-_,............................ ........ .WM_M. ;I--- ----- ----- --:--- ' ­_ - <br /> IPIof plan.showing Sim of�W. location of system I ation to wells, buildings, eta., can be placed on reverse side). <br /> F YOR DEPARTMENT USE ONLY <br /> A REVIEWED BY._......__.................. ------------------------------------ DATE. <br /> _...--x3-ACCEPTED BY....I.................fi..... ... ............... <br /> -----------------------------------------------_--------- DATE...... ................. <br /> BUILDINGPERMIT ISSUED----.....I------- ...-....................................................I...............­... DATE........___.............................................. <br /> me 7at'c:s and/or rocorpefforts..... ............................. ............... <br /> J-enAlter3l g::11............2, 0,�o # <br /> ............­­............................*............................................... .. ......... <br /> ................................ V <br /> ........................................................I......................................... .....................I—......................................................).................................. <br /> .................................................­J......... .......... ............ --------.....................................................................................­ <br /> A. ................................ <br /> Dat,�..... <br /> FINAL INSPECTION BY:........ ... ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 S..th A..rl,cin Stnimill 300 Want Oak S,,..t 124 5yrnmon St,..t 205 Wo.,9th Stir..f <br /> Stockton,Colitonla Lodi,Ccillf.r.tci Id.o.o.,C.11hrric, T,*,,,Ccilif.,rici <br /> ES 9 REVISED B.59 2M 5-62 ATLAS <br />