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j�.Aw-------- -- ----- I --�/f+ r -- - <br /> .G6 <br /> -- - <br /> AP MIT Permit No. �_114- <br /> L---- -- --------------------- ---------- <br /> APP FOR SANITATION PER ,iijo <br /> ----- --- ---------------------- (Complete in Duplicate) _Az <br /> -- <br /> - <br /> ---- ---- --- This permit Expires I Year From Date Issued Date Issued <br /> -_--Pp- <br /> is hereby made to the San, Joaquin Local Health District for a permit to construct and install the work herein described. <br /> L—AA—1—v <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ANeDCATION-..-- _6 --------- ------- <br /> - ------------------------------------ <br /> Z,4,�------------------ <br /> Owner's Name--------- %4"1 <br /> ---------- --------- <br /> Address---- --------4�=------- —---------7--------- <br /> - -- ----- ---- <br /> LContractor's Name-------- -------- ------17!5 .>_t-�r-�­------------------------------- <br /> Installation Will serve: Residence gApartment House [I Commercial E] Trailer Court [I Motel C] Other El <br /> Number of living units: -------- Number of bedrooms _.5 Number of baths Lot size __4 2 --- --------------- <br /> L Water Supply: Public system [] Community system El Private W Depth to Water Table ------. ft. <br /> Character of sail to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam D Clay El Adobe R Hardpan EI <br /> LPrevious Application Made: (if yes,date..._-.-----___.._.) No X New Construction: Yes f K No E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public/sewer is available within 200 feet.) <br /> LSeptic Tank: Distance from nearest well---7 ---.-Distance from foundation__,/��.........Material---4-- <br /> No. of compartments---------k------------Size-tRA- '.c_X_;K_Liquid depth------X-----------------Capacity_�<Oz�t---- <br /> A-,3-I------Distance to nearest lot line_/gIfZ'�--- <br /> Dispcsal Field: Distance from nearest well itl- Distance from foundation <br /> _._a <br /> Number of ----X---------------Length of each Iine_Z:�Z,0_'3-_e;1_<Nidfh of trench--------pl�;;-------------- <br /> L Type of filter material----- ------/9--//-----Total length____-.-�2__Yin------------ <br /> ------- epth of filter material --- <br /> Seepage Pit: Distance to nearest well--------------------Distance from foundation----------------Distance to nearest lot line___._.._.___ <br /> 6. El Number of pits.___.-_.._...-____.Lining material--------------------Size: Diameter_____-_____________Depth--------------------------------- <br /> Cesspool: Distance from nearest well_------------Distance from foundation.._.____.__.__...Lining material...._.__.__._.__.____._.._-. <br /> El Size: Diameter.---------------------------------Depth-------- ---------------------------------..Liquid Capacity-------.---_--------- <br /> Privy: Distance from nearest well------------------------------------------Distance from nearest ---------- ----------- <br /> ElDistance to nearest lot line__. ---- --- ----------------------------- ---------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----- -------------Ne-40------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------_-----------------------------___-------­­------------------------------------------- I, <br /> ------------------------------------------------------------------­-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------------------------------------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> ---------- <br /> (Signed)-------- ------ -- ---- ------ ----------------------------- (owner and/or Contractor) <br /> By:--- - - ----- ------- ------------------------ -------------(rifle)--------- _ ---------------- -- <br /> (Plot plan, showing size of lot, location of system relation to wells, b0dings, etc., can be placed an reverse side). <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- --- --- ----------------------*-- ----------- DATE----- ------_-------------- ---- <br /> REVIEWED BY---------------------------------- -- ------ --- ------------ -------­_­--- ------------ DATE--------------------------------- <br /> ----------------- <br /> �cj 1cf <br /> L BUILDING PERMIT ISSUED-__----------------- -----------------------_------__ ----------- DATE----------------_---------- -------- <br /> Alterations and/or recommendations:.------- <br /> i <br /> ecommendations:----------L ------------------------------------------------ ---------------------------------_,­------------------------------------------------ ---------- —---------------------`----------------__------------- ---------- ------------------------------------------------------------ ---------------------------------------------------------------------------------- <br /> L ------------- ------------------------------+--- <br /> ---- ------------------------- ------ ----*-------- ----- ------------------- ----------------------------------------------------------- -------------------------- <br /> f-- . -_ .- <br /> FINAL INSPECTION BY:..--- _Jor_T�kA-'j---------------- Date------- ------------------- <br /> KIJ AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hax.h..Ave. 300 West 0.1,Street 124 Sycamore Street 205 W.0 9th Street <br /> Stockton,California Lodi,Cofif..i. Manteca,California Tracy,California <br /> IS 9 REVISED 8-59 3- 3,63 F.P.Cm. <br />