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FOR OFFICE USE: PART 3 OF 3 SYSTEMS <br /> APPLICATION FOR SANITATION PERMITi l ? Permit No. .-:/_ a <br /> ..... (Complete in Duplicate) 4 /:Z ( 7i <br /> Application is herebymeds to the Sen JoalsuPeLocal Health Disrmit Expires I Yec+for ar 0e Date <br /> to and instal ate Issued O -.......1...... <br /> the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. p v(:__. F>_ ,9LON <br /> ' 2Z`F22 , n r\ <br /> JOB ADDRESS AND,�La ..._ <br /> OCATION _ ).VA.R ... <br /> t^._�i <br /> 5..-. 1__­1.5.R <br /> ....+?I-D�.......BTW�1<...-��?C7o.IS....d ..--..._R.C..N..L <br /> Owner's Name--....... Q L-1-.). R.....--Rn-t-4-CH-------.------------------------------------_.......................... Phone............................... <br /> Address..........5�2.e~Z EA.......IF ..................M.Pb.m-5xq-- /.. -_--...........------........-................................................ <br /> Contractor's Name../.Yle. 4/v�� -----4� 1 (C---T .............5 H73oYE�. . Phone.Y!Z-'. .g . <br /> Installation will ierve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ +Other 1 <br /> ' <br /> y1 � [1 • c D Number of�4iv;ssrunits: I... Number of bedrooms-6. Number of baths.-_...-Lot size%..A.CR.,EA_,Fs: :-.=.a. -I_....... <br /> ' <br /> Water Supply: Public system ❑ Community system ❑ Private [L]�Dspth To Water Table3_`-�_ ft. f <br /> Character of soil to a depth of 3 feet: Sand Gil—Gravel ❑ SSaandy Loam[IClay Loam dClay ❑ Adobe❑' 4Haardpan ❑ <br /> Previous Application Made: (if yes,date....................) No g( New Construction: Yes [Fr o 11 FHA/VAi: Yes { No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well-IF-0from foundation Capeci+y.... g1! . ddepth . L ':Q....... JIi <br /> 1 <br /> Disposal Field: Distance from nearest well._/4q..Distance from foundation. -.I fQ. ...Distance to nearest'lo I <br /> Number of lines..-------I......................Length of each line..... . . ..........Width of trench........ . .-..-.- �f/s <br /> �." Type•of'filter mtiteri8'I: O:_C ,_...Depth of filter material.... ..-_......Total length...... ....................... <br /> Seepage it: Distance-,to,nearest ell-..-✓Ofl._ADistance..from foundation.__.�L�-.... Distan to nearest lot line....5....... � <br /> Number of piffl.1YZV4*'x.-.Lining ma+eriall.R.0.0�Size: Diameter.yX._�---..Depth----A9._....._........_-. <br /> Cesspool: Distance from earest well..............._Dist1t ce"from foundation...:................Lining material...................................... <br /> ' ❑ * Size: Diameter...................... ..............Dep-.a.................. -----------;..............Liquid Capacity"..,......................gals. <br /> Distance from nearest building.. A <br /> Privy: "'^'Distance"from'nearet9 weB" .............._...--. g-----.-- ---- _----------- <br /> 13 Distance to nearest lot line.........................t*-'--------------.--...................------.....•....... ........`�_:....__`_......_..-- .._ <br /> ' Remodeling and/or repairing (describe):.......F12F ._.,5._ 111.+13-- .-. /.5- ...'d....`/�L?IN.F.} •-L - -------------- <br /> ..-----.........................--.........................••••................• .....----...... ........................ ..------------..................... - <br /> - - ........ ----------- <br /> - .._......................_-- y... ..........................._._........................ -----....-:..... '" - <br /> ' ....................... - --------• •--............... .... -- .... 3- I. ..-----------......--------------------------------........-�--r... -.-.......... <br /> I hereby certify thea I have prepared this application t d(that the work will be done in accordance with'�an Joaquvr=County <br /> ordinances, State laws, <br /> �a rdirules and ulations of tlie,S h J aquin Local Health District. <br /> (Signed) I - - f/�' .........(Owner.and/or. Contractor) <br /> BY ------- ------------•-------------------------------u -- ---^---.. ..........-----.........._(T tie).......-........................ ............. <br /> (Plot plan, showidg.sise ofilet,.loca ieelof system in relati�oe��wpeells, buildings, efc., can be placed on reverse side). <br /> 1 3 <br /> ) FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... *i..R....Q...t.................... ..:.................................... <br /> ....... <br /> DATE......]=.197.42—::............... <br /> REVIEWEDBY................`. ...-... ............................................................................................ DATE........................................................... <br /> BUILDINGPERMIT ISSUED......................................................I............................................. DATE.................. ----_----_........................... <br /> Alterationsand/or recommendations:.........................................'-.............------..........................-•---•..--............................................................ <br /> ' <br /> ............................................._..............----.........._.............. .. ;.........-.---•----...........-,-•-5: ----..r.,r.-.+,� ............................-•----....... <br /> .... <br /> . ............. .. ...... . .............._..............--'---+--------- <br /> ...-.................'-.--.-.......................................- <br /> ........---'........................................ .... ................ ..... ..... ..... ............................... ........--..-...............................-•----.......... <br /> FINAL INSPEC - ---- 'i✓Aj.Dat i. . �: 0-...�?2 '...._._.. - <br /> _ __ _ <br /> SAN JOAQUIN LOCAL HEALTH ,01STRICT <br /> t - 1 ss-- <br /> 190 South Amorimn Strest 300 West Oak Stres) ��24Cyn6ra street 205 West 9th St,..t <br /> Stockton,Collfornia ` Lodi,California 'ManN�tyd,Callfomla T>aq,Cellfornla <br /> 95 9 REVISED 5.59 2M 5.62 ATLAS i f� <br />