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t -UK Vl-NLI: UZ)t: <br />.................................. ----------- Permit <br />'—APPLICATION'1`611 SANITATION PL.,ktAIT <br />00 Duplicate)-' <br />.. ... . ------- ----- --------- (Complete in Duplic Date Issued ......... <br />-------------------- This Permit Expires I Year From Date Issued <br />----------- <br />Application is hereby made to the San Joaquin Local H'ealth District for a permit to construct and install the k herein described. <br />This application is made. in compliance with County Ordinance No. 549. 1-12-0-03 pr e in <br />j <br />rg? & -Tig4c_ 1/ 16 1,,1,0 - t" )1/ 1 <br />JOB ADDRESS AND LOCATION._:��__.,,)_ �__ <br />Owner's Name.}. ..... P" Agt. �-­-� --------- ---------------------------------------- / --- Phone. -AV -0 ....... 7x <br />.... -------- <br />------­---------------------- ...... ......................................................... <br />--------- - <br />-:4 <br />Address .......... <br />Phone................... ......... ---- <br />--------------- ------------- <br />Con4rac�t'o`r:S' Name----- . . ...... <br />Installation will serve:—. Residence, [D -:Apartment, House,E] Commercial ❑ Trailer Court ❑ Motel [] Other Z?" <br />eol <br />Number of living units- Nomber of bedrooms_ Number of baths 4-(_ Lot size <br />-- - -------------------­-- --------- <br />Water Supply: Public system El Community system 0 Private 12-Depth,to Water Table ft. - <br />Character of soil to a depth of 3 feiat: Sand [] Gravel 0 Sandy Loam [3 Clay Loam­[3—CIry Adobe 0 Hardpan <br />❑ <br />Previous Application Made: ',[If yes, date--------------------) No IFT"New Construction: Yes 0kNo o D FHA/VA: Yes 0 &1'= <br />TYPE OF INSTALLATIOWAND SPECIFICATIONS. <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />kJ .1 K�a ial --- .............. <br />Septic Tank: Distance from nearest we Distantfrorn foundation -.1p ------ <br />No. of:7compartments-J-1 ----------------- Si-_ A_Veiqu;d depth—i_3_�04 . ............... Capacity./.. -y_. -0._g0 ... <br />e_�t. �r; D! 1c, nearest lot line.__/At7_.*" <br />Disposal Field: Distance from foundation istance t <br />W �2 <br />Number of lines ...... ----------------- Length of each linelkWe'_4�74$P.. idth of.tre' .trench._. _--------------------•----•-- <br />Type of filter materia Depth of filter material_.. T8tal leng, th..,--A.v ------- I <br />4 4404— 'e Pit: foundation __-_--__'—__...._..Distance <br />t <br />Seepage Distan�e to nbarestwell -------------------- 'Pi"Jance from. foundatio ------ ..Distance to nearest,lot line.....___.....__.. <br />El Numb`_e'�I-of p —Lin ifi-g--materi'al ---------------- }--------Size: Siz4: * Pia%ryTeter ----------------- ------ Depth ........ -------------- -1 ...... <br />. . i <� .. I I -,, -,i F * L -j , <br />.Distance from. nearest well- ---------------_ Distance from foundation ------------------- Lihing material ------------ ------------------------ <br />Cesspool: <br />.-Li'uid Capacity -----------------------­---- gals. <br />0 Size: Diameter ------------------------------ ---- Depth ------------------------_---- :_7 ------------- <br />Privy: Distance from nearest -well ------------------------------------------------- Distanc�; from nearest building -------------------------- --------------- <br />1 2 ----------- 1-1 Distance to -eares' to line-' 71 - <br />13 Distance - nearest line__________________________ ---------------------------------------------------------- I ------ ----------------- ---------------- <br />: -------------- ....... --------------- I .................. ­ -----_--_ ........... <br />Remodeling and/or repairing (describe) <br />........................ -------------------------------------------------------------------------- ----------------------------------------------------- ------------------------ -_1 ------------- <br />---------------------___­­­ -------------------------------------------------------------------- ­ ----- <br />-------------------------------------------------------------------------------------------------------------------------------------- --------­------------ I --------------------------------------- <br />-------­­- I - <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 />ordinances, State laws, ad I and regulations of the San Joaquin Local Health District. <br />R rues <br />(Signed) ........ Contractor) <br />Ti --------------- <br />........... <br />BY:------------------------------------------------------- ......... --------- <br />in relation to Wells dings, etc., can be placed on reverse side). <br />(plot plan, showing size Of lot, location of syst I buil <br />FOR DEPARTMENT USE ONLY <br />----------------- ----- --- <br />-------------- <br />APPLICATION ACCEPTED BY ---- --- - - ---------------------------------------------------------- <br />DATE <br />REVIEWEDBY------------------------- ---------- --- ------ -------------------------------------------------------------------------- DATE --------------------------------------------- ----_------- <br />BUILDINGPERMIT ISSUED ---------------------------------- --------------------------- — -------------------------------------- DATE------------------_---- ----------_-------------_-- _.- —.-r <br />Alterationsand/or recommendations: ---------------------------------------------------- ---------------------._-------------------•----....------------•------ ---------------------------------- <br />------------------------------------------------- ­ ------- ------------------------------------------------------------------------------------------------------------------------------------------------- ................ <br />---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ --------------------------------------- <br />.................. I .................. I ........... ---------------------------------------------- -------------------- ---------------------------------------------------------------- ------------- --_--------------- <br />------------------------------------------------------------------------------------------------------ -------------------- __ ----------------------------------------------------------------------------- ......... <br />11—-6 --- -------- <br />FINAL INSPECTION - --------- Date------ -J ------- 0-_--------2---_-_ -------------- .. _ _-------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES 9 REVISED 8,59 FM 5-61 ATLAS <br />