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FOR OFFICE USE: <br /> ------------ <br /> .....................:..' .„/t'.'3p'._..d'yyf_,.- APPLICATION FOR SANITATION PERMIT Permit No. __: l__7_, ._ <br /> -- -- --- <br /> _ {Comple+e-in Duplicate] <br /> .. Date Issued <br /> ------------------............. This Permit Expires 1 Year From Date Issued <br /> ----- -- <br /> Application is hereby-made to the'San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in.cornpitance. with County Ordinnce o. 549. <br /> r aQ `d ,mak ' <br /> ' s w <br /> JOB ADDRESS AND ATION- /-- --- -- -- - --------------------------- <br /> Ph <br /> -- ---------- ----- <br /> Owner's Name - -- -------- ---------- ' $ - -- ----. Phone .: <br /> •-•-•r <br /> :..._...._. -Y W� ..... <br /> Address-----1------ �Jz uGt ` <br /> :/ --- -- �d�Q/[C /_r _ ' Phone------ ---------•-----_--- � <br /> Contractors Name_._.: �,�.� r--- ---- ------- <br /> Installation. will serve' Residence Apartmen#'Howe ❑ Commerdial 0'. -Trailer. Gourf ❑,�1�rlotelOther ❑ <br /> 9 / <br /> Number of livin units: Number of beltooms _ -__ Number'of''f�aths `Lot size; r' ,1r1_ d <br /> Water Supply: Public system VcommiJnity system ❑ Private El Depfh to Water Ta1Q"_L, ft. <br /> Character of soil to a depth of 3 feet- -Sand ❑ Gravel:❑ „Sandy!-Loam ❑ Clay Loa�W Clay eAdobe Hardpan C1 `. <br /> Previous Application Made: (If yes,date. ...... . No New Construction:--Yes”[ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: a <br /> p t. <br /> I P • P P P ) <br /> .Septic Tankse septic taDistancesfrom nearest well_ ilea Distance®f om foundation-./ _-__--.....Material._. .. __._ �c-lc-_____________ <br /> 1 !"Ica <br /> c}1 <br /> ❑ No. of compartments Size Liquid depth ' CapacitY---------- ' <br /> pislposal Field: Disfance from=nda.rest well.. 1. .Distance from foundation___ f. ___.__...Distance to nearest`1ot'IIM _�__..... <br /> kix <br /> Len th-`of each line-_____- .._._......Width of trench❑ r Number of lines_ d_�-�: gType of filter material.--_/�� Depth of filter material "._ _Total length______ _ _____ ------------------------ <br /> Seepa Pit: Distance to nearest well__._ .. Y ld_f_:__ Distance to nearest lot line--- i <br /> Q-4t-e i}istance r m ou dation _.__ ._ <br /> ef, r✓ - <br /> UT Number of _ _ Lining <br /> material _9_S/ Size: Diameter-'_._- -. ---Dbpth____ ______________'__---- <br /> --pits -- . <br /> Cesspool: Distance from nearest well Distance from_foundation. Lining material_____________________________ <br /> Size: Diameter. <br /> ❑ pepth --' - :.,Liqu+d;,CapacitY' -------------------------- <br /> Distance from nearest well ____ ._Dista'nce'fro'm'nearest buildin <br /> Distance to ne- rest iio�# <br /> r\ ---------------- <br /> fm -'-'-'- . <br /> K '- -- - ------ -- r - --- ---------'------'A <br /> beRemodelin9 and/or repairing descri -- - ----- - --•-------------•---'--- <br /> .. <br /> ------------------------------------------------------ ---- .___ ------ __ ---------- -_---- ------------------------. ' <br /> eFR.,W,'Jtar�+ <br /> --_ ._._____-._..---- <br /> f ._____________ ______ __________________________ ____ -____--------_____._ __ _____--_---._ --------------------------_.__-___--.-.--------------- -_- ---------- _-_-_.----.----- __ <br /> .. fy , - - ___ __�. <br /> __._ __ ^t __---__.,_.------- --------------- ----- 7•._ <br /> ._ - ___---------------____________ --__. __ <br /> Thereby certify that-1 have prepaeed this application and that the`work will be done in.accordance with San Joaquin County t <br /> ' ordinances, State laws, and ruFesr and regulations of the San Joaquin,Local Health District, . -- '•1 <br /> ined _.__ -_ �, Owner and or Contractor <br /> (Si{ 9 )-•--------- { I <br /> -� � Title--- ,. . ..�_. - <br /> (Plot plan, showing size of Idf,- location of system iri relation to wells, buildrngs,;.etc, ca rbe placed'an reverse side]. •_: � � <br /> FOR DEPARTMENT USE ONLY.' <br /> n i <br /> APPLICATION ACCEPTED'BY------------.. ._. I? _ _.. ---------------------- <br /> J - -- DATE:---- _ S`,--.-G 1 <br /> 'REVIEWED BY- i ----- -=-------------- -- - --•----- -- ------- - - ------------------------ <br /> BUILDING <br /> --- ----- - <br /> -. _. ,DATE <br /> , . DATE_----- <br /> LDlNG PERMIT;155UED -= - ------ <br /> e r ' = <br /> Alterations and/or recommendations: =-------- ----' ----- -- -- - ---- ------- -- <br /> ------------------- <br /> - - <br /> y <br /> • •----------------------------------------------------------- ------------------------- ----------- <br />` ---------------------------------------- ' ' ................ ....--'-' ... ------------------- ----------------- ----------------------------------- " ' - <br /> -- - - <br /> ' <br /> . ;,. Date---- ....... J �'9� �' ---------------------------- <br /> FINAL fNSPECTION BY:.____----_ `` >._�' <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> j 1601 E.Ha:eltoe-Ave, 300 West Oak Street 124 Sycamore Street 20S West 9th Street <br /> i Stockton,California Lodi, California Manteca,California Tracy,California y r <br /> E.H.9 2M 1-67 Vanguard Press <br /> ..fns .?r. .. ., � � �. � .n. }'• - ',t`j� <br />