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?LICATION• FOR SANIT4TION PEi,-.JT Permit No. _..__�--�. , .
<br /> <� (Complete in Duplicate) p
<br /> •: v, r Y Date Issued
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<br /> FFF ry.. -S-t--•• r.• - J } If ,....1F,.a .,
<br /> Application is hereby made to the San!Joaqum"Local Health District fora permit`to construct and install the work herein described,'' 1
<br /> This application is made i'n compliance+,with County-Ordinance No.-549.r
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<br /> JOB ADDRESS AND LO.CATI0N__. UT44 _ tuSS-e:I� [�� 1o_�j ..-------
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<br /> Owner's Name .__ - `�
<br /> �f7 2�N Phone T
<br /> Address +
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<br /> Contractor's Name ` ... f ' ,R .. e" j ----- Phon ISI. �V_
<br /> Contra J _�
<br /> Installation will serve: =Residence Apartment House ❑ Gommerc�al ❑ ;Trailer:Court ❑ Motel ❑ Other ❑ .-
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<br /> Number of living units Number of bedroomsZ Number of baths 1_. Lof size
<br /> Wat '75upply:i Public.systemCommunity�system "Prwa,'te [Depth"to Wefer'Table
<br /> Character;of`soil;to a depth of 3-feet:' Sand Gravel' 'i;_Sandy Loam ❑ iClay`.Loam ❑ Clay ❑ . Adobe Hardpan ❑;
<br /> Previous Application'Made: .Yes ❑ No +_-1 New Construction ' Yes ❑ No a,--MA/VA: Yes ❑ No
<br /> TYPEi-OF-INSTALLATION-AND SPECIFICATIONS:;-
<br /> (No"se'ptic tan.or;cesspool perinitted if..publie sewer is available within 200 feet.) i' F' }
<br /> Septic.Tank Distance from nearest'well6Q/ l Distance fromf�g�'ndation._ p _.Mate ' i...(_J....... ... - t
<br /> _.„ . .No.�of.�compartments.. i .Size_' � ?�. {Q tr .:Lig6ia'• epth,� _..Capacity* � ��,r` i
<br /> �J - �i i�...'
<br /> ,rf i . ,,�-
<br /> Dis oral Field: . Distance from=nearest well: Q c.Dis Length'
<br /> et'
<br /> , oun ation �
<br />-' X stance to nearest•I'
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<br /> T u ebof filter
<br /> matenaL:. ,:G .,De thhoff loch line_..:� 1j.�__.Width of.trelc }'
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<br /> Yp er material 1. ..Total length_
<br /> iil - i. l
<br /> Seepage Pit:'' Distance-;to-Beare't,tivell"*�© r"�""-Dist�ts f-urdation" /G Q' Ditty ceyiembare o in
<br /> Number of pits..:, Lining, mat i Size Diameter':._ r Dep
<br /> Cessljt
<br /> pool , Distance fpom nearest;weli istan e'fro fo ion__..':..__:_.:.`._..Linin material:....
<br /> "` a Siz }. Diameter f r x x '-Depth r _Li i pec - gals,S:
<br /> l.. I ------------
<br /> Elr r ..Liquid.d,Ca �.
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<br /> r i I A....
<br /> Pnvy:;ti Dis ance-from. nearest well ___ Dista Ge rom nearest buildin _ —� ' s
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<br /> - ___ VT•n__________________________
<br /> Dis ance'to near s j
<br /> ❑w " e "lot line_.__ ?
<br /> • ' � ^d.
<br /> Re doling-and/or repairi (des ibe� ;__� :_rrJ �•:
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<br />..+'i.' i+.Y-i•.. M ...............................,4 -J - - - .
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<br /> .. '-•--' ...............................................5 .' . '•-�_•�•______.... J
<br /> horekiyseertifysthat�l=ha prep red-this a plication.. dathat�the;work.will be-do a>>n accordance w'th Sari;Joaquin'County
<br /> - ot i
<br /> ordinances,,State laws, and ruib rang regulattnof'Itha Sa oe umiLoca] th 'st pct "' A E I
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<br /> (Signed # a
<br /> L Contractor
<br /> + r ! '•«+!' J J" -F„ ,..#� '.1..r-.-�'u�.�.t � , -x
<br /> (Plot plan, showing size of!lo )ocatioTof systein�relat�ono w}ells' b dmgs,_at an<be`plated on reverse side) 7 '
<br /> 4.L:� p n i Y . Jf I FOR'.DEP:ART.ME USE_ONLY
<br /> APPLICATION A-CCEPTli BY. .' '': 7 ' r ' i l
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<br /> . .DATE_ " , I - t ,
<br /> REVIEWED '$Yi , I s 1 I i '
<br /> BUILDING PERMIT-IS SUED4 . -' ....._ r + ° ATEA ' 1_ y ' 3
<br /> Alterations and/.or'.recommendations: :_„
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<br /> t 1 , t. .� �- ' i i i �_. '..p - , -r } , I - _•_'_fin�............................................. -
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<br /> FINAL�iNSPECTION BY.._:_ � -
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<br /> SAN JOA UIN LOCAL HEALTH DISTRICT
<br /> 130.Soufh American.Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street
<br /> I.. Stockton, California Lodi, California - Manteca, California Tracy, California
<br /> ES---4-2Q Revised 1-57 F.P.CO.
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