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Permit C - ------- <br /> APPLICATIO "it No. <br /> N FOR Si'NITATION PERMIT Per <br /> V, (Complete in Duplicate) 1ZDate Issued <br /> 7, <br /> A I D -A i <br /> Thisf, rA hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described <br /> " , 71-ae o,3 <br /> is 1 2--?4-c <br /> a,��P is made in compliance with County Ordinance No. S49. <br /> JOB A D DSS AND LOCATION ------ - -- <br /> ---- - -------------- <br /> Owner's Name------------------------------------- ----------------------------------------------- Phone- ---------- <br /> Address..... 3;,o....eazvt__z� <br /> '/P_.._---- <br /> ----------- k'- -------- ------------------------------------------------------------------------------ <br /> ......... <br /> Contractor's Name----------,------------------- -�- _20!7_4 -------------------- Phone--- -------- <br /> Installation will serve: Residence [] Apartment House E] Commercial E] Trailer Court E] Motel 0 Other Do' <br /> Number of living units-. Number of bedrooms- -------- Number of baths y_ Lot size ---1d5j0--'-x---747_________________ <br /> Water <br /> 4 7- ---------------- <br /> Wafer Supply. Public system Community system -El Private E] Depth to-Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F11�F <br /> Sandy Loam E] Clay Loam E] Clay Ej Adobe ❑ Hardpan <br /> Previous Application Made: Yes E] No X New Construction: Yes 0 No E] ZZ-1. <br /> -42741 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic lank or cesspool permitted if public sewer is available within 200 feet.) <br /> &Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------ <br /> No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity <br /> ------------------- <br /> ILA4 Distance from Distance to nearest lot iine--.157___i Disposal Field: Distance from nearest we -------------- <br /> Number of lines_____1_____________________ Length of each line---Z0920--------------Width of french-,, <br /> ?___x -- <br /> /--- ---------------I <br /> Type of filter materially....??4S------Depth of filter material----419- ---------Total length --------I-------------- n--- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----_-------------Distance to nearest lot line-..____.________. <br /> ❑ <br /> ine---------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__________________________________._ <br /> ❑ Size: <br /> aterial----------------------- <br /> --------------- <br /> Size: Diameter------- --- Depth--------------------------r-------------------------Liquid Capacity----- - 'als <br /> Privy: - -Distance from n-earis-fwell_____ __Distance from nearest building---------------- --------------------- <br /> ElDistance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe}---------------'---------------------- -------------•-----------•--------------------------------------------- ------------------- ------------------ <br /> ­---------------I——-----------------------------------------------------------­----------------------- <br /> ----------------------------------------------------------------------------------------------------------- <br /> ------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------I-----------11------------------------ <br /> ------------------------------------------­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin'r,"un <br /> ordinances, State laws, and.—rula-sand regulations of +he<S!0—ZJqaquin Local He A District. <br /> �__-10-wnmdmffld�w Contractor) <br /> (Signed)----- --------!A7q7__!------ and, regulations <br /> ------ ....... <br /> ------------------------- <br /> Q <br /> X�v� 6- ----------------- ------------------------------------------ <br /> B ................. ------------------------(Title)_l-'el-I ------------- <br /> (Plot plan, A wi ' size of ]of, location of syst in re tion to wells,..buildings, etc., can be plkqeon reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> Contractor) <br /> a <br /> u <br /> cin <br /> t0 <br /> ty <br /> r <br /> APPLICATIONACCEPTED BY___�---------------------------------------------- ---------------------------------------- DATE- l--- ---------------------------------------------------fi - <br /> -------------------------------------------- <br /> REVIEWED BY-------------------------- ---------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUEDDATE ............ <br /> ------------ <br /> Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------------------------------------*--------------- <br /> --------------- ------------------------------------------------------------­--------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> - ------------------------------------ ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------:-------------------------------------------------------------------------------------------- --------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------------- <br /> 1.�—---------------------- <br /> FINAL INSPECTION BY.-__A0 ---- ------------------------------------- Date---------- <br /> i SAN <br /> ate----------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 6-51 Revised W-2100 <br />