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! rUx Uf- U USE: <br /> it -----------I------------- <br /> ------------ ' • ' ------- � �C `` ► w a . <br /> �- APPLICATION FOR SAiNITA�ION PERMIT Permit No. <br /> '------------------ (Compleie•in Duplicate) <br /> - - " This Permit Expires 1 Year From Date Issued Date Issued .- -_� -. <br /> F Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 1 <br /> This application is made in compliance with County Ordinance No. 549. I <br /> I JOB..ADDRESS AND LO ATION ---I�{-30- --- ��ht P` �v--------------------- <br /> n-YD?7 =� __. <br /> ------------------------------ <br /> Owner's Name F J?_I_D_G.E_ 1 _'tom. <br /> ----------------- ---------- ' -- Phon r <br /> Address.----_--------- y <br /> I ., s , --O - - -R.4--� ------------------------------------ •- <br /> Contractor s Name----f�Y.vt+�E{�_-___--•---'ti-....._ �'_- _-'-'- <br /> ----------------- •------- --------------- Phone.---- ------------ <br /> Installation <br /> will serve: Residence Apartment House <br /> I tt ❑ Commercial ❑ Trailer Court-❑'�Nlo �'❑ Other ❑ <br /> Number of living units: --L.____Number of bedrooms_�y Number of baths 1�1-4 _�_- -- Lot.size _. _- __- <br /> Water Supply: Public system ❑ Communitys stem ❑ P t.'F i 4N.0-1 1 �� <br /> y ❑ Private Depth to Water Table _... _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam 0Cfay Loam ff Cla <br /> y E] Adobe El, Hardpan <br /> i <br /> Previous Application Made: (If yes,date_-_._ .-_._ _ <br /> _ _ I TNo New Construction: "les,❑rNo�A/VA: Yes No <br /> TYPE'QF'INSTALLATION li4ND SPECIFICATION "`—' <br /> (No septic tank or Cesspool permitted if public sewer is available within_20b feet.) <br /> Septic Tank: Distance from nearest well---------__....Distance from foundation <br /> -•tee-�.�-.�'h=�--� <br /> fil NC Material <br /> No. of compartments_ ' ------------------------------------------- <br /> __Size----- ------#------ Liquid depth f- ----- ----- - -------Capacity----- --------------- <br /> Disposal Fiefd: Distance from nearest well.__ ____Distance from foundation..../0--------I.Distance to nearest lot <br /> bDp Num'b'er of lines.Q0-_(...---- -- -. ----Length of each line-_ ._- ` �` <br /> 9 .��- --'-- r.--�.Width of trench. ..__�b�v'_ <br /> Type of filter rrraterial__- OAK L ---- ----- <br /> Depth of filter material- _.. -Q--.._--I Total length__--/-__- J-, <br /> ,. -------------=---------------- <br /> Seepage Pit: Distance to near 'st-well:_:_.JQQ-- Disfiancefrom foundation------------------ .Dista e to nearest lot lin;--, ___ <br /> Number of its..--- _ -. g1'--_- Size; Diameter_9 X-._ . - <br /> p Depth j ------- <br /> Cess ool:- Distance from nearest well_-_._____-__.__Distance <br /> p f__-_. - .__ Lining material-_ <br /> from foundation_.-_ Y ----- Lining material--------------------- J,---------. <br /> ❑ Size: Diameter_ __ _________ __ __ __ <br /> Depth ---------- ------------- ----------------------Liquid Capacity'- --------- --------------gals. w <br /> Privy: Distance f16m,nearesf well. I` _.-` Distance from nearest buildin <br /> ❑ Distance to nearest lot line ----------- ?r..-._.:.__ _. T g` - ) <br /> - ----------------------------------- -------------------------------- <br /> ----------------------------- <br /> Remodeling and/or repairing (describe):-__-_j._...-.__N-El%-(- _._V�"k 11V5.37nL ...{ f <br /> --------.: : <br /> aP _41T_c n1._- -_Aj x5------- <br /> W_F-c_-�------- n/Ep - <br /> I 1- - <br /> ---------------- <br /> ;­-------------------------------------------------- - <br /> - -------- ------------- <br /> ------------- <br /> --------------------J-------- ------- - --------•--------------- - <br /> hereby certify that I have preParea:this application and-Mat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regI'lions of a San Joaquin Local Health District. <br /> 4,i <br /> 5� Wed -------------- <br /> , <br /> _ :.:_.__-...:._f__ <br /> _�,.. -----..�_. --- -------------- - ---------------Owner and/or�Confractor--) ' <br /> By:------- ------------ ---------------------- - ---- <br /> --------------------- -- - - <br /> {Trtle1 - ------------ ---------- ---'--'-' ---' <br /> showing-size.of Iot,TlocafonTof systemin.relation to wells,_buildings, etc., can be placed ori reverse side). <br /> t <br /> • _ { , <br /> FOR D.EPAItTM1rNT 1,35E ONLY <br /> APPLICATION ACCEPTED BY_.. _.�, - , ~ / <br /> ---- ------ ---------------------------- DATE <br /> I-- — <br /> REVIEWED BY.----'- ------- -' ----------- --------- <br /> -- --- '------- �4 •--•-'--------'--- - - I <br /> ------------------- DATE_ _- <br /> BUILDING PERMIT ISSUED------------------------------- I' <br /> - - ------- DA'TE-------- ---------,--_ - -------------------------------- <br /> -Alteratiens and/or recommendations:_--�,_ti__________ __ __ '- -_ _ --k �s --------'----- --------- --------•-------------------------•---------------- <br /> -_" ' --- _-._ ._..-•---------------------•---------- <br /> s V------------------------- -- - ----------------=t- .. -----------' <br /> y <br /> �.'. --'•--.. -- ------------ <br /> -------------------- --- <br /> - ------- --------' <br /> — ------ <br /> FINAL INSP N. BY:- - _ <br /> - -- ----- --:�= Date <br /> _... --- _.. r <br /> SAN.JOAQUIN LOCAL HEi dWCilS_+ ICT <br /> 1661 E.11a:elton Ave 300 West Oak S+realw <br /> 124rSycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California �' <br /> M_ onteca,confornia Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press E <br /> - � A <br />