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FOR OFFICE USE: - <br /> ---------------- ---------- -- --------- <br /> --------_-.- APPLICATION FOR in SANITATION <br /> `NATION PERMIT Permit No. �• <br /> ------ ---------------- -------- ( p uplicate) <br /> -`-------- - -- ----- ------------- ........ This Permit Expires 1 Year From Date Issued Date Issued 45;�-f'7--- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta€I the work herein described, <br /> This <br /> �,ap licati�On isemaad` in com iance with County Ordinance No. 549. <br /> JOB A R(jSS AND LOCATION _ _ F,•r/ o ��"'��' �����as.9 <br /> Owners Nam -��.3_ _ �s' /�!/ .f vS ? i <br /> Address-----•----- -----• - -- - - --- 7�C� <br /> - / -------- 7� 1 <br /> Contractor's Name------/¢// Q6 LS �16�6s �{J�� <br /> - -- ------- -- --------------------------- ---------------- Phone------ ------ <br /> Installation will serve. Residence Apartment House ❑ Commercial ~Trailer Court <br /> ❑ " ❑ Motel ❑ Other ❑ <br /> Number'of living units: -- ----- Number of bedrooms __2_ Number of baths -- ----- Lot size ..... ... ........ . <br /> Water Supply:' Public.system ❑ Community system ❑ Private IR Depth to Wgfig�r­Table ......_ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam'b ti Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ <br /> Previous Application Made: (If yes,date,. ............... ) No ❑ New Construction:- Yes,❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Not septic tank or cesspool permitted if public sewer is available within`r200 feet.)' ' <br /> Septic Tank: , Distance,�rom nearest:well-..._��6 __Distance frofn and,pfior�_.._jQ_._. -. Material ....__- !Gly <br /> I No. of compartments. __-.-_. !.____--_Size__, f�_6 X e� iquicl depth - �/ ._ Capacity---- <br /> / -� <br /> Disposal Field: —Distante...Ji --.._ .....Distance Distance from foundat n__._i a__ _ a Distance to nearest lot lime ��,�_- <br /> Number of lines_________ _ Len th of each line_ff -/wo-_/-Width of french..___--._2 _ <br /> i Type of filter material}SE G *Depth of filter material____.!f__"___-)...Total length--___/ f/-____ <br /> --------------- <br /> Seepage Pit: `r Distance to nearest well-______________=Disfancefr-om foundafion_:_=__:_._- _.Distance to nearest lot line_-._____-.._-._- j <br /> ❑ Number of pts--- ------------------Linin/ <br /> g material_________ __ <br /> - Size: Diameter_- - ----Depth----- <br /> Cesspool: I Distance from nearest well ---Z.........Distance from foundation_--------------._ Lining material------------------- ----- <br /> f$ Size: Diameter- -- ----------- -- -- <br /> ----- ------ Depth----------------------------- t <br /> - �--- ------� ----.-Liquid CapaeitY-----�-�-------------�----•-gals. <br /> Privy: tr, Distance from nearest we'll-_- '____________ ____________ _ Distance from nearest building ' <br /> �; ------- g--- •------------------- <br /> ❑ Distance to nearest IcVIine------------------------------------------.----_ <br /> 4 <br /> Remodeling and/or repairing (lesce,}i---------------------- <br /> -•-------- -'------------------•------------- <br /> ------- -------------------------------- ------ -. <br /> - - �-'" /--- -----------------------------------------------------••-- ----- ' <br /> =-:--- <br /> I hereby certify that I have prepared.this application and.that fhe.work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rulessandfreguiafio s of the San Joaquin Loca€ Health District. <br /> t <br /> (Signed) <br /> - -------- -------------- ---------- ------- (Owner wvdy <br /> By:. --------- -. - �--r ---- ------ ------- --------------- ---------=--- ---------------------"...(Title)-- ------------- ..........._- <br /> ---------......... <br /> (Plot plan, showing size oflot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ 1 _ GU.Q- ------- --------------- --------------------------------- <br /> _...-- <br /> REVIEWED BY. - = ------------ - ------ --------------- -- DATE <br /> BUILDING PERMIT ISSUED------ ------------- DA-TE------..-.-----------...-- -- --- <br /> Aiterations and orr7ommendati <br /> / -•-----••------------- <br /> .- ------- 0sr_4.....- ,n4---.. f RQ..d A/..CvJlf? /I� <br /> --_,x1.--ff- — f------- ... fes- �n _ __ <br /> r pw � Qi -_� ------------ ---------- <br /> r <br /> FINAL INSPECTION BY:.---._._..__° ��.•*� Date <br /> AN�OD fJN LOCAL HEALTH DISTRICT / <br /> 1601 E.Haselton Ave. 300 West Oak Street _ r 124 Sycamore Sheer <br /> 205 West 9th street <br /> Stockton,California Lodi. California e_ Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Prass <br />