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FOR OFFICE USE: 1-4. <br /> 1 <br /> I ......................................................... APPLlCATlONvFOR. SANlTATION PERMIT Permit No. -„/.,6.7.._x_3 <br /> -----....-............... <br /> .........,................. (Complete in Duplicate) �. <br /> .............. -......--.----. --....... t This Permit Expires 1 Year From Data Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constructand i II he work herein described, <br /> This application is made in compliance with CCount�y�Ordinance No. 5,,44. /-{/a ry A- <br /> )7 j��r� ' <br /> JOB ADDRESS AND LO ATION_J...-..-:-..L\ t..._�O_K..Pw. ..... k _.� 1.1.�1W ....kd 3� oG <br /> I �6- <br /> Owner's Name.......;".---�--.J" •P ' .. ...._..Y/. :'... ( .. <br /> b Phone . .. <br /> ' <br /> Address------_-------L�..1....I. -- <br /> k VS.,_.......-------------•----------------- . <br /> Contractor's Name.............Q� l$. ... 1J'.lylQr .........d�t7 ..,...!Phone,. - <br /> Installation will serve: iResidence [I Apartment House ❑ Comme ial Trailer Court 13 Motel- (//] Other ❑ <br /> Number of living units: ........ Number of bedrooms ........ Number of baths ........ Lot.size ........�.�Llbl... <br /> Water Supply: Public'system ❑ Community, system ❑ Private Depth to Water Table a1?..� � <br /> ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayE] Adobe Ot- Hardrian ❑ <br /> Previous Application Made: (If yes,6te.--------_:........I No New, ❑ NoU Construction: Yes PHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , ., <br /> (No septic tank or cesspool p�rmitted if publypwar is available within 200 fe't.j ! M feria l� 1 <br /> Septic k: Di#ante from nearest w I..R%4Pista d rgmrf u tlonY ' C. <br /> go V <br /> s�¢}�� th. fid...----..... <br /> No.of,compartments.._......-.. _ Size.:.?11.......J1.'f.,...Liquid d p+h }_..Ca ac �J <br /> C <br /> Disposal ield: /''r/Distance_froW4arest'we11._%B�- P - � ( P -.. � 1 s <br /> y.. r {hDistance from foundetion.�� {yl.Distanca to nearest lot Ike.r.J►sr.yy <br /> Nufiberbf lines...%.,,.�_ .n..;.. -.-- Length of each line-..___. _.09-0. Width of tench_... r <br /> Type offi(YcYmaterial:� 7.f.`d.��r'Depth of filter material....... 9! ,. Total lengA..._.__­­019.... -•__- <br /> f . <br /> Seepage Pit: Distance to neares+'well..._!:...............: istahGe from foundation....................Distance t nearest}lot line............. i <br /> . , >, <br /> El Number of pits.- ---.Lining m,aterial,!....................Size: Diameter.........................Depth..._,_:....-.---....-......... r <br /> Cesspool: Distance from nearest well---.........:'�2Distance,frWfoundation-------------.......Lining material.......!?_!...........'t.._._........ 6 <br /> ❑ Size: Diameter....---_-_--------__....._- Depth............ \;�-----......._.-•--------Liquid Capacity:,.,. ---...--- -...gals. �0 <br /> Privy:* Distance from nearest well... _�^' <br /> _.T_-,__T .._„- .Brstznce.from_nearestbuild ing_ .. ................... <br /> ❑ Distance to nearest rat line---1..............._........-.._..._._....------.............. <br /> • Remodeling and/or repairing (describe):....L/../�.r- ....:�.`.,ayl ,F,!feL..t..._ �0. R. 1 r <br /> YY 0 .. .. /- <br /> I ............. .........------ ---- --- <br /> - -- ....-----.. t <br /> ! 'Cox ' '-------------------------------------...... <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 /> ordinanWSfataand rules an regulations of"the San Joaquin Local Health District, <br /> t(Si �`..l. ..>... ._........... ....----'--`-----....:..i...........------(Owner and/orContractor) O <br /> By:.....................- i------...._...---- ..c1,; ----jr (----------------------------------(rifle)-------._...------- -_ - ---- <br /> oe <br /> (Plot plan, showing size of lot, location of system on relation'fo`wells, buildings, etc., can be placed on reverse side). <br /> { FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY......:.j......-----'_._:_'.�-'�----i...................... --- --- -•- - -�-- ATE-------/ -� r <br /> REVIEWED BY......... ... ................�- ........ ----......__ F --- DATE...........:....... <br /> BUILDING PERMIT ISSUED...............:........... 41" - - <br /> Alterations and/or recommendations:.._..._... —" - - <br /> » -- <br /> ::.: :::. ',��t-�`••''�� <br /> / - . <br /> ......................................._.....................:..._.._._....................._....._........... ` -••-.,1- .�j.[. _ <br /> ..............................................................�........ -................4... .... / <br /> .:. .. �L <br /> FINAL INSPECTION BY:. ----.._... ---..-.... Date...........:_c................i' ......... <br /> • +`- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollen Ave. 300 West Oak Sneer 124 Sycamore Street 205 West 9tk Street <br /> Steckfon,California Lodi,California Man Mca,Califmnie Tracy,C.14rnfa <br /> CS 9 RCVISED e•58 3M 3=63 r.O.CD. - <br />