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- l�yfi1S \asa.,,a,J•• " Permit No. .�. ..1.--.1.:-. <br /> APPLICAfi1ON F4(.,.,. SANITATION PERMIT <br /> (Corns Ptete in Duplieete) i6 <br /> DatawIssued•-----�°��'! <br /> ' ti. <br /> j Application w hereby made To the San oaquin Local Health District for a permit to construct end install+ha•work herein,d�sciibad. <br /> This application is made inc'"ompliance ith County Ordinance.No. 549.^w Ari t <br /> n ,'ice .^:3...:............................ <br /> JOB ADDRESS AA LOCATI�TI---.. ...:/...OU -- _.... - ���� .. ... ,� w afr <br /> r- { �� <br /> Owner's Name.-'-' -`-------- - - <br /> Address---'...............__.�'� - '--....-—r._�`�L.:.��f-- -------- <br /> Phone <br /> __ _I t.. �� <br /> one. _ , <br /> i - 1_ ._. <br /> Contractor's Name...-r- -'........... Phone.........._.--t._...- - <br /> yavfcs .` <br /> Installation will serve: .•Residence ❑ Apartment Hquse ❑ Commerclel �ail'er Court ❑ Motel v❑; Other [T'i� <br /> Number of living units: -_-_.... Nun"Il'ief Of•tmd�s____.- Number of. _ --r--- :�•--•--- 1 <br /> Water"Supply: Public `system ❑ Community system [Private Q�D�pt to etas 1'asfe .....-.-ff.- <br /> Character of soil #o e�epth of 3 feet:+ Sand ❑ Gravel ❑ Sandy Loam❑ `lay Loam ❑ Clay❑ Adobes Hardpa'❑ <br /> F4fA/VA: Yes No r <br /> Previous Application Mede: Yes ❑ No,Q New Co!struction: Yes ' No ❑ ❑ <br /> 7. <br /> f' TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I (No septic tank or'eesspool permrTtedjf publc sewer is available within 2W feet.) <br /> }. i --•; <br /> Septic Distance from-neares+ �1- "Le �istance from foundation-.I f -!...Matence nears -: <br /> t of con artments•-- size...AR..` -------d "'_Ligwd de �a�1.--..._.--.---Capaci+y.rfGlQY7r-.. <br /> Disposal Field: Nis once fro'n nearest we11...�.�.4 :a.Distence from foundation_�/./P_ .•-__.Dist to nearest i e.. ..t_ <br /> { Number of lines......... .- -.-_---- .aa Length of each line__-.-,4-&-----------Width of trench-...:�r6.. ..- ....... <br /> 1 c ` --� <br /> Type of filter materia/tDepth"of'flt8'r materiel.--Mel length.-...f3.Q: <br /> r i, 1 <br /> �.Seerp�a Pit: Distance to nearest Dittance rom ouB a+ion.. .. istanca to nearest),ot Item..-�J <br /> Number of pit :4 material-:ySize:'Diameter... .f. . .--.Depth_.h,.�-.�ti-..------....-_ <br /> r .i tl 1 , a' .. 7" <br /> 1 • Cesspool: Distance'from nsares+a, 811:.._,.,.-''_ -Distance from foundation....................Lining material_..............v.........;_,. <br /> Size: Diameter-._1...f t . Depth......: . -.._-----`--'-"-----:-Liquid Capacity.. -----."^--'--"--.{.gals.' <br /> I. ........... <br /> - <br /> Privy:: Distance from nearest .------ -- <br /> 'welly ,_, - ----.... ....._Distance from nearest building... .-_................................. <br /> . :, <br /> -Distance to nearest lot line`.............................................. <br /> J , Remodeling and/or repairing idesc ib `5 --------'---- ------ ' '• �1�� -... -------- <br /> -..........{1. ..-- ... _............ .. - 4 ..................... .. .. <br /> 5 y P <br /> I hereby:eerfify that I have prepared thisepplieetion and that The work will be done in accordance with San Joaquin G�ounfy <br /> ordinances, State laws; and rules an tr6ns the Sen Joaquin Local Health District. <br /> q <br /> i (Owner and/or Conhlactor) <br /> Sr ned - - ---.- - <br /> By:. .. -- - l Title Y <br /> (Plot plan, showing size of lot, location of system in'ielation to wells, buildings, ate-, can be placed on reverse side). <br /> t: {-FOR DEPARTMENT USE ONLY I <br /> }� <br /> APPLICATION ACCEPTED BY - - ..._ - -... -----------------'.............. DATE. f , r��/s*. . �j ------- <br /> -------------- <br /> DATE.............. .- -------REVIEWED BY'•------- .--...........`...- = - - - -- -- -- .. - --- <br /> BUILDING PERMIT ISSUED--'`- -- <br /> - ....., - <br /> 1,- " "-"s........::.....::.. --_ ------ DATE <br /> Alterations and/or recommendations:--V-)�Fi .:,.1 LT.....t?NI+J!.....�.0-...--FRS2M.....-4>sl4S ••--174f�K5 Sili-L�--" <br /> KFilr_t­�.---'f-.-.S T O.V.r........ <br /> � ..-- � _�r:...-PiT, <br /> .......--....-$a RsR:4 -- <br /> +. <br /> . . .....--...... ---.... <br /> _....:._.-.-.. ... ..... .................... <br /> - _ _ ..... ......................................... _..... ................__..l <br /> pp p� cq <br /> FINAL INSPEC B Da+e-:..-:(. <br /> • 8R ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 30o West Oak Street 134 Sycamore Street 814 North "C" Street <br /> 130 South American Street - Tra<y, California <br /> Lodi, California Manteca, California <br /> Stockton, California ' <br /> i <br /> ES-9-21A • Revised 1.57 F.PX0. <br />