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.r <br /> OLICATION FOR SANITATION PEL.AT Permit No. .--Ja.r <br /> (Complete in Duplicate) f <br /> .., - +x,� - ar r.r... .. " a,...,..�_.,_Date_I swgcl,• <br /> -------- ----------- �`This'Permit Ex ira3 9 Year`Frorrl'Date"lssued ""� ar <br /> c i t r �4i tt7 iE1 y <br />! Application is hereby made to the San Joaquin,-Loca!_ Iealth.:Distuct forya perms# to constrict and install the work herein described. <br /> This application is made.in compliance wii'h_"County-Ord inance`'No.°549.­-•~•--.w.•,� �•.„ r <br /> i <br /> JOB ADQRESS AND LOCA ION__ -��Z-:�'IPL� 3 4�'..� '.......= •... <br /> � �y Y <br /> 5 <br /> Ownens Name.- t ?""'l_....-•• --- 1. -': :.:....::.:..:.......:.:....... Phone.............. t. <br /> Cont actor's Name--�-•-- ---._-_• ..!'------------ -•----.-------•-----------•-------------�-------------------------•--------------•--...----------•'. Ph p�ne..�'----------4----- '- --•• 9; <br /> itj � t + r .............................. 3 �. .�.. , <br /> 1 . Installation will serve: ' Residence Apartment. House ❑ ,CorfTlmercial ❑ Trailer ,Court ❑ Motel 0-0therl <br /> k iNumber of living units: __ ._._. Number of bedrooms umber of baths _ ___. Lot size <br />!. Waterj Supply:, Public. ystem ❑' Community system❑ Priva te< epth to Water Table :'!sPf,}r1 ! .. - <br /> ` �W� ......�..y� •`fi'Z. <br /> Character of soil taa depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam[.Clay ❑ Adobeardpan ❑ ,:,` : , <br /> . I i <br /> Previous Application ad {If yes,dot -..:._.._...______-) No New Construction':,._Y,,es- . o.. Fi VA: Yes 'No <br /> o._ ,f <br /> _..F A/ . [ . <br /> TYPE OF INSTALLA,f10 AND SPEC! ICATIONS: ,_ <br /> �:. <br /> a(No septic tan or esspol perm ed if public sewer-isPavatlable wi}hin 200 feet.} of <br /> It ,fir. � 1, ' � x F <br /> Sep#ic Ta�'In c: Dls an a romlrneare t weIL.,,f- .... Distance.from found fjora�:�p__...__.Mate�iai__�srAV_ _� '...-:_.....T .. _: ;- � <br /> j [ to pa ent ,. Size_ Liquid depth-----�._'-_.-'-__-_-__.Capacity..'y���---- <br /> D+sposal field: Dista e frc�fn ntre t well_-..- - D+stance from foundation___ _______.__.Distance to nearest lot lie ._ :. ` <br /> Numb ,o, nes._ Length of each line__ p ........Width of trenchr' „+ �:-__{_...__ <br /> ft --- ---------- 9 .... <br /> Type { ltiIr, Tl I_, 1 '� -Depth of filter material_.___. __-�.____-Total length. ----�'•�- .-t_--•- -i <br /> Seepage Pit: Distan a knr rest oIL_____________________Distance from foundation----...............Distance to nearest lot liyle------:..- ....... <br /> x. <br /> 01 Numb ---Lining material..:...............___.-Size: Diameter-:'+c.....................Depth•.................... <br /> Cesspool: Distance from nearest well ------ _:Distance from foundatlon..1..............Lining materials.....-.-._...:. ............ <br /> i....... <br /> � <br /> C]; Size: Diameter--------------------. ..-.. Depth Liquid Capacity...................... .gals ,31lli <br /> Priv 4' Distance from nearest well....'.............................................Distance{from nearest building f ' <br /> Y 1 9 t' t <br /> : <br /> Distance o nearest lot line................................................. ..._ <br /> _ I <br /> • -a <br /> I i <br /> 4, <br /> •---• - <br /> f � t .....f..... <br /> ...Remodelin9 and/or repairing (destribe):----•-- } <br /> .._._...---------------------------------------------- �-----•-•-•--._.....-•----•....................... .. <br /> ••...........- ' -------------- ...........................-•-............ <br /> I'hereb certif that I have prepared this a ' lication'and-thaf-the-wti�k will be done in accordance with San................ <br /> a f <br />` <br /> It'hereby Y P p PP .....�..... ty . <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).....= ----- C ... = - - <br /> ----�----- sem..--- --•----��.L'. --. .:� ,9_: :�;:: r�ontractor) { <br /> By:--------------------•--------------------------•-•----------•----------------- L -•---------(Title)-- ---'-- <br /> (Plot plan, showing size of lot, location of system in re on to wells, buildings,'etc., can be placed on reverse side). <br /> FOR DEPARTMENT;USE ONLY <br /> APPLICATONREVIEWED` BY_•ACCEPTED BY ........... 3 -DATE `Z....`5 ... . - +1 <br /> ••---- <br /> I BUILD+ING PERMIT ISSUED ISSUED------------ -................................... ._....... <br /> ..... <br /> -! DATE....................... <br /> Alterationsand/or recommendations:......................... <br /> ...... ........ ............. ....._...._._ :_-•-. --._...._....__. <br /> ...---....:..._............-._-- _ - <br /> � <br /> ---• i l` W1 <br /> �• <br /> ------------------------------------ ------ <br /> ___-_......__.._...._l.____________._ ..____.___.___.-_._...___.._..................... :gip <br /> ' a <br /> s <br /> .-..._..--••------'---...---••........................'-'------------'• -• ..................................._.._..tom..... ................._...-.....__......-.-.---•-•--'-'----._.....--- -• -------------------------- <br /> FINAL AL INSPECTION BY:--- ......�`t �............. ...•--._. ..... Date._.. `... .... <br />( SAN JOAQUIN LOCAL HEALTH DISTRICT. f. <br /> 1601 E.Ha=often Ave. 300 West Oak,Street µs y `: 1's1A Sycamerg,Slree* ' 205 West 9th St:eet ' <br /> Stockton,California Lodi,California "' Manteca,California . Tracyr California l l <br /> - it <br />