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��: L Permit N / <br /> ----_ -x,30 a PLICATION FOR SANITATION PER4 a <br /> 0110kO- (Complete in Duplicate( <br /> This Permit Expires 1 Year From Date Issued Date Issued ....1�._�_. .. ._(a.. <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> LThis application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND//�L�O� CATTI/ON_.....7_,7/4------- 4�1. ��... ...--- 4.....................------- --------------- <br /> r_ Owner's Name.......d�l-`----�'=-�..-`-' - -- -_- ---------------------- ---- ---------- one-- ---------- ----.... <br /> / �y Ph ! � .0 <br /> Address----e5l- Q - l ��E -« v- - -u---------------------------------- <br /> - -.._._... <br /> Contractor's Name__._...- 4z�C+[ tf. - - ._ Phone - -Z' <br /> Installation will serve: Residence 2'] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __� ..�Number of bedrooms ._/_ Number of baths .1.. Lot size _.t 1 d._.X/..Q.- ------------------ <br /> Water Supply: Public system ®-I"Community system ❑ Private ❑ Depth to Water Table 19 ft <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a-'Hardpan ❑ <br /> Previous Application Made: (If yes,date ..... -_._...J No ® New Construction: Yes ❑ No [tYFRA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> t (No nk:septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> a • Distance from nearest well....-------------Distance from foundation--------------------Material----------------------------------- <br /> _04i <br /> No. of compartments--.-- -------- -�-�------'----Size------------------------------_Liquid depth-------------------------Capacity---.`_--`----_----- <br /> Disposal F : Distance from nearest well/.t0;X-.Distance from foundation__.,3..A._--__..Distance to nearest lot line___sS__.___.. <br /> Number of lines........J.- -- Length of each Iine....J�U....�_.r....__ Width of trench... .��.. .................. <br /> If <br /> ` Type of filter materiai..;tt �n Depth of filter material.... .. ........Total length....__.___.._....-..I.V ---I....... r <br /> Seepage ' . Distance to nearest well.._Distan m-ff undation__?Q...... ^D�istance to nearest lot line__._%5... . J <br /> / Number of pits--- material _Size: Diameter__..J.i. _�.__Depth__...o�.,Se..�._.___._..__ 6 <br /> Cesspool: Distance from nearest well_-_............Distance from foundation---.-------------._.Lining material-----------------..................-. <br /> ❑ Size: Diameter.-. ------- ----' ---------------Depth------------ --------------------- --------Liquid Capacity—.........................gals. In <br /> _ Privy: Distance from nearest well------------ -------------------.--------- --- -.Distance from nearest building .............-.................... <br /> ❑ Distance to nearest lot line --- ----------------------------- <br /> Remodeling and/or repairing )describe):----------- ----------------- ----------------------........... ----------------------------.-......----..-.................. S <br /> r <br /> ------------.......-- ------------- ------------------------------------------------------------------------------------------­----------- --------------------------------------- ----- <br /> -----------­-------------- <br /> ------------------------------------------------ -----------------_------- --------------------------------- - ------------------------------ ----- -------------------------- . . ...... <br /> I hereby certify that I have prepared this application and thatthe work will be done in accordance with San Joaquin Colin <br /> 6 <br /> ordinances, Stat aws, nd rules a d regulations of the San J quin Local Health District. V <br /> ----- ---------------------------- - <br /> (Signed).--_.....--_-- -`--'- C�+�} yfQ-caner and/or Contractor) <br /> --------------------------------- ------- - ------ -- -------- -----------------(Title). ---- - �-----------------------­-- <br /> By: <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). <br /> _ /�._FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> �.T...• .-. -------------_----­-----­-------- DATE------... <br /> REVIEWEDBY.--------------------- .....-............ ------------------- -------------------- --............................. DATE..................................................---- <br /> BUILDING PERMIT ISSUED...--------- ------- ----------------- ------........ - --... DATE----------------------- <br /> - - <br /> ` 'S_ .._...__.t+t� _.L_!t_ <br /> Alterations and/or reeomme ati ns:--/- Z -_i.-=---- - ``-�="" �----------------------------------------...._...........__..:......----- <br /> -.tea:-�s-- ----�.�, --Qr ..._...--F/.�` - ........................ - - - -- - .. <br /> bee ---------------------------------------------- ----------- -- -- - ...................­­--------------- -.........---...................-.....-..................................-........... <br /> ---------------- ---. .-- - <br /> - - -_ ......................_ <br /> ----- .-- --- ------. .......---------------- <br /> FINAL INSPECTION BY:....._C47V Date 1.'.2,C4 -------------------S` - ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Xorallon Ave. 300 West Oak Street 144 Sycamore Street 705 West 9th Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> v.P co. <br /> r <br />