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rvK vrril,c c: <br /> .a AkwOCATION FOR SANITATION PERN�a- <br /> Permit No. <br /> ------------------ ----------------------------- (Complete in DupBcafe) <br /> Date Issued .... .1.te........ <br /> ................................................ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION....- L/Ql lclXilti✓...e CX.C-_-----------------..._.__....-----....._....._........... <br /> Owner's Name...........3 y y �� a ----_ -..... - ........................... <br /> Phone_.............. <br /> -..._..__.. <br /> t <br /> Address..................----......... �yOy[�,,� - .................. __..................— -- _...- <br /> Contractor's Name.--------- 1 *4 -- � --.........................•-•----....------......._.................._... Phone - Y•••: <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Uf TjOjr-ee- <br /> Number of living units: ........ Number of bedrooms -------- Number of baths ........ Lot size ..``1J....!-.Q__. 5...../..._.. <br /> Water Supply: Public system ❑ Community system ❑ Private �th To Water Table 7 ._ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made•. (if yes,date------------ -------) No New Construction: Yes ❑ No [y;_-fFrA_/VA: Yes ❑ No"C3� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welL_G­fJ. ---...Distance from founds+ion...Z.d..... _ <br /> .....MLatsriaL....C��. -Y/-G� _ <br /> No. of compartments...__.. ... <br /> ... .__.___.._Size...._, u.a. -.Liquid depth....Z.-/-��._._ .Capecity......fd' ..... <br /> Disposal a d: Distance from nearest well.%50!...Distance from found a *Ors—A-�_......Distance to nearest lot line.--- <br /> ae Number of lines---------1........................Length of each line_.. A..................Width of trench...�:.y............._{... x <br /> Type of filter material....Y..o4r.1.>!%...Depth of filter material...J.�.__s .... length....:;�..:......................._..... <br /> Seepage Pit: Distance to nearest well......................Distance from foundation---------------_---Distance to nearest lot line................. <br /> ❑ Number of pits.....................Lining material----------------.------Size: Diameter...... Depth_------.------............---.. <br /> Cesspool: Distance from nearest well.................Distance from foundation----------------....Lining material..................................... <br /> ❑ Size: Diameter------------------------------------Depth---------_-------------------------------------Liquid Capacity............................gals. <br /> Privy: -- - Distance from-nearest-weU=.--.-....-----------.---.----_....._ distance-fromneerest-louilsfing........... <br /> ❑ Distance to nearest lot line--------------------------I -.----------------.----------------- .. _. -- <br /> Remodeling and/or repairing (describe)_----------------_fl-<-- ... �'�'��--- - -•-- <br /> ------------­......... ------. --' ----------------------------------- ----- -------------------------------------------..__------ <br /> I hereby certify that I have pre ,red #his application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stafe S. and <br /> as lations of the San Joaquin Local Health District. <br /> (Signed.....---- ._.. .1� `... ..(Owner end/or C tractor) <br /> -- <br /> -----------_........ --� - --­---------------------- <br /> BY: (Ti+la)- t <br /> (Plot plan, showing iae location of system in relation to wells, buildings, etc., can be placeT on reverse side). } <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYZZ4... .- . r"—_�------------------------------..------.... DATE ��� = - ....... <br /> REVIEWEDBY-................------- ................-----------------------------------------------------------................. DATE.................-...............--......... <br /> BUILDING PERMIT ISSUED----......................... .................. DATE........................................................... <br /> Alterations and/or recommendation :.._fpsZ_' � ....ArT --- ...............--------••----- .. -----�.......................- <br /> ........................ n�------- 1-�` --.........I -- ----...................-...................... -------------•--------- <br /> ------.-----------------------------_--------------------------------------------------.....................................................---------...._-------•-------------------------------•--------------- <br /> ------------................................................................................. . ---....... . --------••---------------•------------------------------------- ................. <br /> __ ----......... ......... ----- ---------�/..��....-------------------------------------------- _. _ - .. . .................................... ......................... <br /> FINAL INSPECTION BY:._ / / .•- <br /> Date-.... -------/-..- ----..... .......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sant 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Mant.ca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />