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FOR OF.Ft(;E USE.. <br /> ............. -F <br /> L----------- APPLICATION. -OR SANITATION PERMIT Permit No. <br /> ------ ----------------------------------------- -------- (Complete in Duplicate) <br /> ------- ---------------------------------- - <br /> ---------- This Permit Expires I Year From Date Issued Date Issued --7. <br /> Application is hereby made to the San Joaquin Local Health District for a 4ermit to construct and install the work herein described. <br /> q <br /> This application is made in compliance with County Ordinance-No;-549.- <br /> .;"Tu <br /> _5 // -, <br /> JOB ADDRESS AND LOCATIQN--------- ...4!f__> ----- .........Z­....................... <br /> ..................... .. ....... ----- ----------------------- <br /> Owner's Name-----------------/� ...............411.41.1.1,11, ---------- Phone................................... <br /> - ----- - --- ---------------------------------------------- <br /> Address...........J--- ........(.2 <br /> .................... ....................-------------------------------------2........................................................ <br /> Contractor's Name---- ---- 11:7._ ........I-----------------------------------------------------------------............................ Phone................................... <br /> Installation will serve- Re5idence`ff, Apartment House [] Commercial [:] Trailer'Court ❑ Motel 0 Other [3 <br /> - / <br /> Number of living unifs: 3W... Number of bedrooms -------- Number of baths ........ Lot'size ......................................................... <br /> Water Supply: Public�syst4rn Community system 0 Pri�-atj'o_Depth to W;f_;F�Tablek,------- ft� <br /> f <br /> Character of soil to a 'depth of 3 feet: Sand [] Gravel ❑ Sandy-moa • Clay,Loialm'jt` Clay.[] Adobe[] Hardpan C] <br /> Previous Application Made. (If yes,dote--------------- IN�o,8 New Construction: Yes 1 No [11' ' FHA/VA; Yes [3 <br /> NoI <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------- afel al_-------- ...................................... <br /> 0 No. of compartments---_---------------------size---- _-------------------------Liquid depW.....--------------------Capacity...................... <br /> Disposal Field: Distancel from nearest Distance from found;tion:____1_G__- ..Distance- to. nearest lot line----- ...... <br /> Number,of lines----------/.........------------Length of each line---------Zk? ------t.Widtk of'rrelnch-----A-4---------------------- <br /> _rteType of',filter material------ Depth Wof,fi'lter material........ length......... ------------- <br /> Seepage Pit: Distance to nearest well__ Distance fro founplafion....... -------Dlsta�Lce to ne�rest lot line <br /> ..L?............ <br /> i t, CA <br /> Number. of-pits---------------- Lin Size: Diameter-------�/ Depth.- X:0 I <br /> I 4;r�_ in I material...................................... <br /> Cesspool: Dis'tance from nearest well----------------.Dist6rice-from foundation--------------_----Lin gi <br /> 0 Size: Diameter------ -----------------------------_Depth.-'.*--------------------------------------------------_Li uid Capacity...........................gals, <br /> Privy- Distance from nearest well----------------------stance to nearest lot line ---------------------------Distance frornXtaresf building--------------------------------------------- - <br /> 0 - <br /> Di ----------------it <br /> ----------------------------- ----------------------------------- ------------------------------- <br /> Remodeling and/or r4pairifig (describe):-------------------------------------------------------------------------------------------------'---------------••-----------------•---............... <br /> ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> 1_�- --------------------------------------------------......... ---------------------------------- ----- <br /> I herebycertify that I:have pripare ---------------------------------------------- <br /> ............ ---------------------------------------------------------------------- ..........................L---------------------------------- ....................I-------I—--------­­........... <br /> djhis application and that the woA­will be done in accordance with San Joaquin County <br /> ordinances, State laws, and. rules and regulations of the',San Joaquin Local Health District.,' <br /> Isigned).__ .. . . . .. ...................t------------------ ----------------------------- --------- ...... ............ --------(Owner and/or Contractor) <br /> By:................ ---------------------------------------------------(1-100)----------I----------------------------------------------------- <br /> ---------------------------------------------_-- <br /> (Plot plan, showing size' of-lot, location of system in relation to­wells, buildin'gs, etc., ca�be placed`on reverse side). <br /> -FOR DEPARTMENT USE ONLY-,` <br /> APPLICATION ACCEPTED BY------- 24� 4� --------------------------------- <br /> ---------------------------------------------------------- <br /> REVIEWEDBY--•---••---- -------------------------------------------------------------------------- -------------------------------------- DATE--------------------------------------------------I...... <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------.....---------------- _------------------- DATE-------------------------------------------------------------- <br /> Alterations and/or recomm9' ricraf ions------------------------------------ <br /> ------ ------------------------ .. .............'- ----- <br /> --------------------------­----------- <br /> - -- ----- -- ---- ? <br /> -7 ... <br /> ------------------------------------------------------------------------------------------------------------------------------;.......------------ ................)---------------------------------------------- <br /> ------------­----__----------------- --------------------_---- --------- -------- ---------------------------------------------------- --------------------------------------------------------------------------- <br /> ------------------------------------ ------------------------------------ ----------------- --•-------•----- ------------------------------------------------ -----------I------ -------------------------------------------- <br /> 7— <br /> FINAL INSPECTION BY:_-__.:_ .i_ Date--------T ------------------ <br /> -f-0----------- <br /> ',.-SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ct 9 ftcvirco e-og ZM 8-6t AILA13 <br />