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...................................... <br /> ...................................... __ __ A `..CATION FOR SANITATION PERI ,,. Permit No. <br /> ........ --. -- ------------ ----- - --- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and <br /> F <br /> si�ILthrworl I�r ode ribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-.HA-9-D.!-1\/AA �� G GV.A --7L2 W- -•'---. `` ��. C�'_1 ....... <br /> Owner's Name......... . 0__�. -7-QIY_.-------7 } - �.- _�•. Phone <br /> Address.......................4 K � <br /> Contractor's Name - - f_-_' /1 P2L -------.-5.0 tv'5- - ------- ------------- -- -- ------.-._ Phone.4&tom 7lt.'t'`.7•-- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 0< Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .. ___ Number of bedrooms ___.-.- Number of baths -------- Lot size --A <br /> Water Supply: Public system ( f Community system ❑ Priv'ate.0 Depth to Water Table 70. ft <br /> Character of yil to a depth of 3 feet- Sand ❑ Gravel ❑ S'antylbam ElClay Loam ❑ Clay E] Adobe,( Hardpan ❑ <br /> Previous Application Made: (If yes,date_. _ .. _ .._.. ) No E] New"Co struction: Yes N No ❑ FHA/VA: Yes ❑ Nog <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Qistance from nearest we1IA/CiVE.-Distance from foundation-/0...._._._ Material --C-Q-_(t.1CA.C:T .-_-_ <br /> ® No. of compartments. __-_....._Size4r.X--- Liquid depth_.+ �Z. Capacity_40 _- n <br /> Disposal Field: Distance from nearest weIIIN0I.VC-Distance from f* dation__la...........Distance to nearest lot I•ne-_.`�___.-------- <br /> 19 Number of lines ___�____ .--._-___----Length of each kine../42f __�--1-1--------Width of trench-_4- -r-____-_____.___- ^� <br /> Type of filter material_ ___--....Depth of filter rhaterial-_�._f---------- length... _-Q.-fes...................... V <br /> Seepage Pit: Distance to nearest well-.A1.6/ ___Distance.from f ffdation--. _#_._._.Distance to nearest,lot lin;__�•�_.__.. <br /> Number of pits.4 -Lining material.940t, <br /> _.'. Size: Diameter_34-..VQ --Dept h_.i jr..................... <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--___--------.- . Lining material.............................._-_-.. <br /> ❑ Size: Diameter- -- --- ---------- ----------------Depth. "------------ -------------- ------------------Liquid Capacity. •----.............---•--••gals. <br /> ` Privy: Distance from nearest well-______________________________________---.--_-Distance from nearest building-____-_.--••.__.--------.--_,...___.--_ <br /> ❑ Distance to nearest lot line-- ------------------------------- --- ------------------•------- - <br /> Remodeling and/or repairing (describe):-----.:-s f, 456.4--.......FJi.LL........PA-!�Irfl- , --- Q 7 j` '. ---------------- <br /> --------------------------------- ---------------•------.-•---- <br /> -- -- - - - - <br /> A__P ....,-C......... .- P,'4 -------------------------------------------------------:-------------.._................................. <br /> 3.............r-----------------------I- -------­--­- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, StateAaw57'X"'rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - - ; - w __ ... (Owner and/or Contractor) <br /> BY: ,+w--------- . . f -- (Title)------- `Ct-- -----------...._ ----- ........ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.,;�W. - -- = --------------------------------------- DATE '/ 7 <br /> REVIEWEDBY----- ---------------------------------------------------- ------------- -------------------------•---------•---••------- DATE <br /> BUILDINGPERMIT ISSUED........ -- ------'--'--------------------- - ------ ....—...................................... DATE............................................................. <br /> Alterations and/or recommendations:. ----••-••-•-------------- -......................................................... .............................. <br /> -----------------------'--'•---•---- .. --------.........---•--...----------------------.....----------•-....................................... . ........................................................................ <br /> .......................................................................----•--- -------'•-----'-......._...----•••---.....•-•-•-•••••---••-•--'•-•---..--••-•-••••••-----..._.._.._..••--•'•-•••---•-•-------------•---'•-•-• <br /> .............................................................-......................-.................._......--•-••---- -•---......-•--•••--••'..................................................................... <br /> FINAL INSPECTION BY. Date •'-/�4- 77....----••----••-•----.............................................. <br /> 4- -- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />