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41 ArPLICATION FOR SANITATION PEK.AIT Permit No.. .......... .......... <br /> (Complete in Duplicate) - <br /> 1Date Issued -- - ---------- a --- <br /> 1�75 <br /> Application <br /> licafion is hereby made to the San:Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This � <br /> application is made in compliance with County Ordinance No. 549. <br /> 21 / 7 /X -4 <br /> JOB ADDRESS ) _ lt��----- ----------------- <br /> AND LOCATION-------•- ------ ------- ------ Z .�------ <br /> r <br /> ------- AC,6 ------ Phone--- <br /> Owner's ------ --- ------ - -4 A---- ---- -t-i(s, <br /> Address------------------------------------------ .......... ------- -------- ---_------------- <br /> Contractor's Name-----------------------­-- L_S_\A_,_TjPL_C----------------------------- ---------------------------I--- Phone----- <br /> Installation will serve: Residence E] Apartment House 0 Commercial 4��r Court 0 Motel 0 Other 0 <br /> Number of living units: -------- Number of bedrooms -------- Number of baths .--I_ Lot size _cAP--­X__)!-�------------------------ <br /> Water Supply: 'Public system 0 Community system [I Privateo Depth to Water Table,00/0 ft. <br /> Character of soil to a depth',of.3,❑ <br /> feet: Sand [j Sandy E]Gravelo SayLoom ❑ Clay Loam [J_Clay 0 Aclobe2� Hardpan [-] <br /> Previous Application Made: Yes 6`—NoK—NewConstrucfion: Yes g, No 0 <br /> TYPE OF INSTALLATION All ND SPECIFICATIONS: <br /> 'i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well/C_4:Z"_Di5 t tance-f-ro'm foundation- ...... <br /> n1s--------- ------Si ---��X F_7A/ _LiquiA depth---Y_ <br /> No. of compartments---- Z At <br /> from -frjm foundat- <br /> Disposal Field: Distance I., neare2t well__ *' Distance IW-- Distance to nearest lot line------- <br /> Number I iines---------------- e_k__Length of each line___-__ - Width of 4encI­j_!7_1-.7,!!._ &------ \1 <br /> or f� Off <br /> Type 7 11 aterial---_If---------Total len 0 _A,__*j <br /> ter material--J- z --Depfk of fi;ter m i I <br /> Seeps Pit: Distance to nearest weII_.1_0_0__'_____Distance f )m foundation------;L9-`_Distance to neare§lot -------- <br /> efer--.- *# !2'. -------------- <br /> Number of pifs------/------------Lining mateflal J_43---------[Depth-- <br /> --------Size: Diam <br /> 'orn nearest we ................... )---------------------------- <br /> Cesspool: Distance well-----------------Distance from foundation Lining material__.___-, <br /> m lquid Capacity------- --------------------gals, <br /> n Size: Dia ------------------------------------- -0 <br /> Privy:' N Distance from nearest well-__----- �2----------------------I...Distancer from nearest buildin'--- <br /> ng__-_______:',}_-___--___-___.___----_. <br /> FiDistance to nearest lot line-------- - --------------------------------- ------------- --- ---------I----------------------------- <br /> Remodeling and/or repairing (describe]:_' <br /> -----_-------1P------------ ------------------------------- ------------- - ---------------Z;Za;------------ -----------------7--------------- <br /> j t 0'. _?_ ------------- <br /> ----------------------- ---------------------------------------------------------------------------------------- <br /> ---------------------------------------------I-------- ----------------- <br /> ----------- --------I---- ---------------------------------------------------- ------------------------ <br /> ------------------------------- - -- ------- -------------------- <br /> I hereby I prepared the will'be'd i6--a' co-rdaince with San Joaquin County <br /> _i::erfi y A + I h."; , -application and thaf� e one C <br /> ordinances, Sfafpe , and cdl I nd�reg a+,cns of the San J' ' uin,4Wcal alth District. <br /> -------- zt-,..... -- -------------------------------�E�------ Contractor) <br /> (Signed]----------- ---- - --------- <br /> - --------------- <br /> By:--------------_-- ------------------------------------------------------ ---- --- --- ----------(Title)---Xj <br /> (Plot plan, showing size of lot, location of system in rel6tio, o 4wells,+jildings, fc., can be placed on reverse side). <br /> A <br /> 52,KEP*RTMENT EISE ONLY <br /> .;. <br /> APPLICATION ACCEPTED BY---------- / Z <br /> -------- ------------------------------ DATE- <br /> 4 ----F_x--- - -- -------------------- <br /> - <br /> 0 <br /> REVIEWEDBY---------------------------I----------------- ------------------ ----------------------- ------------------------------- DATE-------- -------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------- ----- ------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------- --------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------- --------------------------------------------------------------------- ------- <br /> -------------------------------------------------------------------------------- <br /> ---------- ------------------------------------------------------------------- ---------------------------------------------------------------------------- ---------------------------------------- ------------------ <br /> -----------------------------------------------------------------------------------I-e---------------- ----------*---------------------------------------------------- ---------- ------- <br /> ------- <br /> ----------------------------- <br /> ----------------------------------------------------------------- -------- ------------------------- ---------------- --------------------------------------------------------------------------------------------- <br /> FINALINSPECTION BY------------- - ---------------------------I----------17 - Date--------------- - --------------------------------------------- <br /> 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 10-52 Revised W-2100 <br />