|
FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT Permit No.
<br /> -------- ------------------------ -------------
<br /> Off
<br /> ----------------- ----------------- -------------- -------- (Complete in Duplicate) Date Issued
<br /> ------------- This Permit Expires I Year From Date,lssued
<br /> ----------------- -------------------- ------ L
<br /> Application is hereby made to the San Joaquin Local Health District for a pe'remit to construct and install th;1work HeRein described.
<br /> This application is made in compliance with County Ordinance No. 549.. 2-
<br /> t&f
<br /> JOB ADDRESS AND LOCAfibN.W--EKD------OF---------FKF-
<br /> :Wftla------i -- ----------
<br /> - ---D.--=------VV_-----------op-----14W>Y---
<br /> 4.01
<br /> Owner's Name____________ --------0,�--- --------- ---------------------------------------------------- --------------
<br /> Li�4a/Address--------------- 5QX---------- --------------------------------------------" 11.
<br /> w -4 ------------------------!,.Phone------------ --------------------
<br /> Contractors Name------- ---------------------------- ------------------1-1----------------------
<br /> VTr
<br /> Installation will serve: Residence Apartment House 3 �,CommerciAl oiler Court R117 otel El Otl�er
<br /> 64 - AE]
<br /> .d^oom��� Number of, 4ths -------- Lot size -*--A�FAG- -------------------
<br /> Number of living,units,:7-`f---- Number of be
<br /> Water Supply: Public`system El Communitylls-ly", '��rivrtll Table ft.
<br /> .t6m EJ#O.Depth to Water -------
<br /> Ali
<br /> Character of soil to a depth of 3 feet: Sand " .4e&ravel E] Sandy Loam [] Clay Loam ❑Clay 0 Adobe M Hardpan E]
<br /> FI es E] No
<br /> ---------A�--- No�/New Construction: Yes 0 El F
<br /> Previous Application Made: (if yes,dot
<br /> .TYPE'j0F..,INSTALLATION AND SRECIFICATIONS-
<br /> ewer is ay
<br /> (No septic fank, or,C'esspoofPerrrii-ft-e-.d-'�if-,.pu�.�,,�.s, aila'ble within 200 fie-+'.)
<br /> *�.4 144 - i ,—. . op
<br /> Tank: Distance 4Lvnearesll'well---5V-------Distance from foul-dafic,
<br /> Se stance fro I----J49---------- fer ia I J?rED IN- -----
<br /> qv--------
<br /> p -6-XT ---Liquid cl,pth-- ---capacity--------- ------------
<br /> N o of.corp rt"m ------ ---Si,e--6.X
<br /> f co
<br /> Disposal 'Field: Dist. nh Ze if Rb m nearest well...,RQ----Distance from foundation---- ----./tistance to nearest lot.line
<br /> Length of each line
<br /> ----�Vidth of trench_._.___---------I -----
<br /> N imber f �ines
<br /> afer -------------------- Total length
<br /> /Type of filf�e�.�m iaI--R6.X�jK.--'Depfh of filter material-----1,40------------
<br /> ,A"
<br /> N, a st
<br /> Seepage Pit: Distance fo nearest well.,._-------------------Distance from foundation----------/-----------NstanGeto-ffe ine-----------------
<br /> El Nurriber of 1pifs----- ----- ------ Lining 'Material---------- ------------Size: Diameter-- -----------Depth--.-----11--------------------
<br /> 9-11,-------------------------------------
<br /> Cesspool Disfance,,fi-om nearest well-----------------Distance from foundation---------------- ---LIning materi
<br /> AK. It
<br /> Size: Diametef�------------------------------------Dept h---------------------4-----------I-------------------Liq*`uicl Capacit y----------- ----------gals.
<br /> Af building______._________.___-..._-_.__--._-___._.v�� M (0
<br /> Privy: Distance from nearest well----------------------I- -
<br /> ---------�t__________c__________-_._Distance from near
<br /> MW -'%
<br /> El J�dsfance� o.-neareJ118T lin-e-"d---W ---------------------------- ------------------------ - --------
<br /> to
<br /> Remodeling and/or r6 airing
<br /> ------------------------------------- -- ------------------- --- - ------
<br /> Sit- m4s.1-ig
<br /> ........ .... . .. .... ... ...
<br /> C
<br /> ---- - -----
<br /> XA,F�. A W> 0 -1 -------AWF—W� ------FOR.........71�--------------
<br /> ----A/0 W------- Fo.'K--------97-------- Nq
<br /> -A-01h-AA?,t4A-L-------- -------ALAX6---- ------Evff�!4-T- -------------
<br /> I hereby certify fhVj,hhve,Orp�a red this application and that the work will,be-done in accordance with S'arNJoaqulh County
<br /> �aquih
<br /> ordinances, State laws?tAdrftles and -reju-1-a"flons of 4reASan Joaquin Local 114e,Ith6isf,ricf.
<br /> '00�0(C-_
<br /> 4 011114,��V A. ner-rnd
<br /> (Owner rd!l�or Cohtracfor]
<br /> ----------------------------------------------------------------------------
<br /> (Signed)--r-t64--- ---------- --- ----
<br /> 0
<br /> ............... . ...........
<br /> ----------- - ---------------- ----------- -------------------
<br /> (Plot plan, shcWjn4�si f lot, location of system.in gelation to ells, buildings, etc.-.,can' be7placed on side).
<br /> I qz � 0 W
<br /> -1- - ir — ,.4.
<br /> -,J"""-AV- - FOI;6,DEPART9ENT USE O-NLt7.77111
<br /> 7;—6
<br /> APPLICATION ACCEPTED BY--------- `.I.7,-ll'------ --------------N-------------- 4DA -------
<br /> TE----------- ------ -
<br /> REVI`ETV'E'D- BY------------------------------------------------------------------ - I'------ -• -N------------------------------ DATE---- --------------------------------
<br /> BUILDAGPERMIT ISSUED------------------------------- --- ---------I--------------------NN----------------------- DATE----------4------- -----------------------------!-----------
<br /> - I ---- -7; -4b --A � Zs(? F&TO:WT-1E7------
<br /> Alterations and/or recommendations: ~3 -X--W30---631-- ----- -�*A-CWE!n - l) ---- - --
<br /> -.10-------4ra.�AC-k4---------- ------------3-6-", .....`,7' ,o=
<br /> 7rJ3!tP4`t----------
<br /> -6-F--b�----- -------
<br /> /-------PIN7—------U Z111F
<br /> -------R ie-------Qtw�; -1-------------
<br /> ---------------------- -- ---------------------------------------------------------------------I-------------------------
<br /> --- - ---------- -- ------------ -------------------------------------------------------------------- ----------------------------
<br /> ---------------...............---------------- 1 . .
<br /> FINAL INSPTION BY- -- ----- --- --------------- Date---------- 7- ---
<br /> -- --43- -------------------
<br /> F - r___ -
<br /> A OT
<br /> SAN JOAQUIN'-LOCAL 11411-TH DISTRICT
<br /> 1601 E.Hazelton Ave. I 300,weitgo.k SiCetlAW IS eIll 24 S411 Street 205 West 9th Street
<br /> Stockton,California Lodi,Calif arm Mla% N,!,
<br /> Manteca,California Tracy,California
<br /> ES 4 REVISED 8-59 3M 3-'63 F.P.CC, (Aki'd T
<br />
|