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OFF Cf USE4j.: ......... s i _ 4 `` <br /> t 3t _ �� F Permit No. --L•- <br /> f4PPLrOA71ON- F�R�SANITA�(ON.PERMIT <br /> . . <br /> .. '-' e" ( ompkte in Duplieafe{ . Date Issued .:_�Pl.�.41.."•Z <br /> ::: `::::-: - This Permit Ex fires 1 Year From Date Ittuad�+ f or <br /> h ascribed. <br /> Application is hereby made toithe Sen Joaquin Local Health District for a permit to st nd iK I;th 1 �.r <br /> This application is made in cor8plience with County Ordinance N 4� <br /> �i <br /> T .. `- . . ---• - "----- �...f <br /> . ... <br /> JOB`ADDRESS ANOCATION.._-.-•-c- --r- - <br /> — <br /> Owners Name.---.... �_... �......� _ ._--- .___....-----......._---......---.. <br /> _. <br /> Address.---... _ e................Phone <br /> Other r <br /> •- - - tel ❑ <br /> Contractor's Name.....................•--•--- Treier rt ❑ <br /> Installation will sante: Residence ❑ Apartment House ❑ Commercial ❑ <br /> ----•--------•--••----•---- <br /> t Number of living units:.--.- Number of bedrooms .-----•. Number of baths1�. . . of size _. �- <br /> �1 PPy tY Y ❑ Depth <br /> to Water Teble,�- ft' Adobe erdpan❑ <br /> Water Su Publics tem 'Conimtni s stem Private ❑ P r t <br /> Gravel ❑ Sandy Loam❑ Clay Loam❑ <br /> IWO <br /> ,Character c4 Sal to a depth Cl <br /> of 3 feet: Sand ❑ , , New Cons+ruction: Yes o ❑ FHA/VA:Yes ❑ -No❑ <br /> 1A <br /> Previous/Applice}ion Mede: (fyas,date.---------•••-- ) No ❑ <br /> '.4TYPE OF INSTALLATION A D SPECIFICATIONS:' war is available within 200 feet.) 1 <br /> (No septic tank or cesool parmiMed ' - Q.,.•.,Mat ri I 1 `' t---- <br /> e�r <br /> istan from un at' n.. Caped <br /> Distance om nearest well - -•• S`�sX �"t•q <br /> tel <br /> Septic T q( ,]fit � Q <br /> ^� - Size. . LI and-depth <br /> �. <br /> (X i No. of c4mjartments;...._... s ` ....� <br /> Distance from founde}ion_4-10--••---•Distance to nearest lot line <br /> Disposal a d: Distance rom neerest�well e ---- <br /> Len th f each line_ Width of trench /7- <br /> 1�Q--....__...y... <br /> Numberrof lines,._.__ _.-- - 9 Total length <br /> �e ._be th of filter material......- ---�-- <br /> Typ�ofIter material._ _ -� P Dis tic oto nearest lot line...s�. <br /> { Distant m f dation...q.•O---- t . <br /> Seepe rt:t , Distance Ito nearest well �>d 4. - 7 <br /> qq Size: Diameter_... ......_...Depth._...q-� <br /> ` Number bf pits.:..ps.._......._Lining material_ - <br /> M • ,gals. <br /> Cesspool: !.e Distance from nearest well.........•`.::.Distance from foundation .,.Liiq id material - - ' <br /> Li uid Ca ci <br /> es Size: Diameter..--- _------------------------ <br /> Depth.. Distant f _.__ <br /> ❑ r' •---- .... <br /> Privy: �+ Distence(`from nearest well..._.T...._''------------•-- Distance from nearest building.:- - <br /> - ...... ...- <br /> 1 ❑ <br /> Distance' to nearest lot line..... .......:�.t - - ' <br /> �' <br /> l . ._.............. fJ..�M:� <br /> Remode in and/or repairin (describe):...... I "-- <br /> _...._ _-.._.---_----- _.............. <br /> - <br /> _...._ <br /> _ 1 ......-......_......---...-. <br /> I hereb cert' Iicatiori and that the work will be done in accordance with San Joaquin n <br /> r } I {lave prepared-this-a p' <br /> V ordinances, ate , and rules a regulations of he San Joaquin Local Health District <br /> .. Con <br /> 1 - .1 t <br /> (Signed)­­ --•--- <br /> n and/o tri or <br /> •.------ - ------- , can be placed on reverse side). <br /> (Plot Plan, showing size of lot, location of system in relation to wells, buildings, r <br /> FOR DEPARTMENT USE ONL 4 <br /> APPLICATION ACCEPTED BY: --- .................. -- - - `f.-• -... .. DATE..----- <br /> DAT -----------------------------------.. -- <br /> t. <br /> 1........................ - E.. . r <br /> REVIEWED BY..................... ......---- --•---..... <br /> ...._ <br /> v - -----... ct.. ........... ....i <br /> , BUILDING PERMIT ISSUED_..----_---•---- � /� ....- -•- - •••- ----•• -- <br /> Alterations end/or recommendefions:._lir .-<�..Q. •---CR�.------"----•- •-------- <br /> __:.....- ...................._... ..:... ....................-..........._._........--••--.........._....... ... . ... <br /> ` 1 <br /> 4 <br /> t .......................... ................. ....... <br /> .........._.......... .. <br /> FINAL INSPECTION BYI1 �c.l:---.- <br /> p SAN JOAQUIN LOCAL HEALTH DIS T <br /> T 124 Sycaman Sheaf 105 Wert 9th Street <br /> Sao Wait Oak Sweat Tra <br /> ` s7,,,y,California � 4 <br /> 130 South Amarl<an Street manhwa,ealifarnia <br /> Stockton,Callfo , <br /> yrnla 1iLodi,calllamla ^ <br /> E6 9 N[VISED 8-]9 iM 1-61 Ai L.1 <br />