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'r OR OFFICE USE: <br /> � 5 GGA __ <br /> - },�7� <br /> APPLICATION' FOR SANITATION-PERMIT Permit No. ....................... <br /> _ (Complete in Duplicate) <br /> ------- ---- - -�---- } Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to�theil! anlJoaquin 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. J <br /> JOB ADDRESS AND LOCATION' _---------a--`" ------------------------------------------------------------------- <br /> =--------- <br /> -Al <br /> Owner's Name---jC------ ------------------ Phone------------------------------------ <br /> 1 Address--•--•C-j4?21-------- ------------ a --------------------------------••--------- ------------------------ <br /> c <br /> Contractor's Name--- ---- ° = ----- T Phone----------------------------------- <br /> Installation will serve: Residence I,p/Apartment House E] Commercial E] Trailer Court [IMotel [:] Other El <br /> Number of living units: ---1-4 Number of bedrooms :_ Number of baths -./-___ Lot size , `Z? -1 __•----------------------- <br /> I_ <br /> Water Supply: Public systemi8�--Clmmunity'system ❑ Private ❑ Depth to Water Table jcft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe 23---M-ardpan ❑ <br /> Previous Application Mad {If ye _ <br /> s,date------------- ..__.i No New Construction: Yes•Zj-leo ❑ FHA/VA: Yes f on <br /># TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or:cessgool,permitted if public sewer is available within 200 feet.) <br /> e. 'i F <br /> Septic Ta Distance frori� nearest well__^__.-_y Distance from foundation__:__1J____.i..-_-.Mater L____.._�-._--_-____ ...............� <br /> No. of com airtments... -__---Size____cF-_�L-6 _Liquid.depth_._'�---------------Capacity.,. ���- <br /> p I = <br /> Disposal Field: Distance from''nearest well.—.- --, from.foundation_ ---------Disfiance to nearest lot line._�________- <br /> 'material- �aL__ .=___De Depth of filter materlal_._�t r -Width n trench..._a��.- - �' <br /> es----r-------- ----= gth of each line__ 1? c. } � ------------- <br /> Number <br /> �_ <br /> T eof filter ' � ..__.Total length---------�1J_____________' <br /> See�pag/e Pit: ,. Disfance to nearest well___'__________________D,istance�from foundation lf---- --_.Distance to nearest lot line_. -_____ <br /> " 'Number of pifs___ ______..______Lining material___.-1 49c.E .Size: Diameter___ <br /> 3 P Deptn -------- <br /> Cesspool: Distance frond nearest well-----------------Distance from foundation-------------------Lining material-----------__-..___.___.________. <br /> I ❑ Size: Diameter---- -----------------------------Depth---------------------------------------------------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well........:.:......----------------------------.--Distance from nearest building--------_----�------------.-------------- <br /> . <br /> ❑ Distance to nearest lot line----------------•----------- ----- ---------=---------------------•---------------- ---------------------------- ----------: .R------- <br /> Remodeling and/or repairing (describel=---------------------------------- ---------------------------------------------- ---- ----- <br /> # ------------------- ----------------------------------------------------------------------------------------------- --- <br /> j <br /> I hereby certify'that-:l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , nd rules sand regal ' s o he San Joaquin Local Health District. { <br /> ----- <br /> (Signed)-------------- _ �. {__ -------- <br /> --------------------- <br /> {Owner and/or Contractor) <br /> .2 ------- <br /> Il ; <br /> r <br /> BY� = --'----------------------=------ =, _(T.itle)- ------------, : =................ ............. <br /> t <br /> (Plot plan, showing size•of Iot';jocation of system-in 'relation to wells,buildings, etc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -------- - DATE-- <br /> - T 3 �� --------------------- <br /> REVIEWED <br /> ------ ------------ <br /> REVIEWEDBY----------------------------- ----- --- ------------------------ ---------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------;�------------------------------------------------------------------------ <br /> DATE ------ -------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------------------------------ ---------------------------------------rs�i--------------------- ------- <br /> ----------------------------------------------------- <br /> __________________________.--_-__.--_---.--_--....--_.____r_._______._______.. <br /> ---------------------------- ------ ------------------- ------ --- --- ------------------------------------------------------ ------------------- <br /> -----------­----------------------------------------------------- <br /> ------------- --------------------------------------------------­­----------:--------------------- <br /> -------------------------------- --- -_____- ..___,--___..-._.__...__-_--_---_-___.._____-_.-___.____..._ <br /> ti <br /> --_ 7 <br /> FINAL iNSPECTI B ' �--- - -------- - --- -� 'r� Date-------- - --------------- -- ------------------------------------------------- <br /> SAN <br /> --------- -------------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1501 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street205-West 9th Street <br /> Stockton,.California Lodi,California Manteca,California Tracy,California <br /> F.RCO.', • .. <br /> 0 <br /> r <br />