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F R OFFICE USE: <br /> - -- --- ------ ------ <br /> �` WPLICATION FOR SANITATION PERMIT Permit No. _.J-._ _ <br />--------------------------------------------------- ----- <br />------------------ -------- ------- ---- - (Complete in Duplicate) vV <br /> Date Issued _______ __36_ <br />------------------------------------------�,�- --- This Permit Expires 1 Year From Date Issued <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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AAD LOCATION------------- 4--------t=�e?------ 11 ---------------------------------------------------------------------------------- <br /> Owner's Name----- --- ------ - -•---- /-------------- ------------------------------------,_. Phone <br /> Address+- u - ------------------------------------------------ <br /> Contractor's Name- .._.. d ------------------------------------------------- ------------- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [) Other ❑ <br /> Number of living units: __ __ Nu bar of bedroom__ Number of baths _ __ Lot size - _________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4--5- ft. <br /> Character of soil to a depth of.'3 fest: Sand ❑ Gravel 0 Sandy Loam p Clay Loam [- Clay [] Adobe ardpan ❑ � <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No i2-**-F_HA/VA: Yes ❑ No <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 Distance'from foundation--------------------Material_________________________________._._____...-__. <br /> !� No. of compartment - Size-------------------------------_''Liquid clth------------ --- --------- <br /> -_- Capacity-- <br /> ----- <br /> ---------`------ <br /> Disp sad: Distance w Ira ,/4-- -------Distance <br /> est lot line- <br /> It <br /> yNumbeof lines ----------l Length of each line-- _ At _Widthoftren h --- -------- ------------- <br /> ,.. <br /> Type <br /> Total <br /> l � -- _. <br /> length_f - -_0 _ . --------------------- <br /> __________________._--_._-. <br /> ._ <br /> t: �i`tance to nearest we ____�r.________Distance '. undation 'l4.r. Distance to nearest lot line__ __..__Seepaq m:8 . -__�t / umber of pits.--------).____._.___Lining material.-.' <br /> _.__.Size � ._...__.Depthsr�.hro <br /> -4 <br /> e s oo : Distancefrom nearest well_________________Distance from foundation._._' _. . f_ .Lining material- - ------------------------------- <br /> ❑ Size: Diameter---------------- - --------------- Depth------------------------------------------------------Liquid <br /> d <br /> Capacity- --------------------------gals. <br /> Privy: Distance from nearest well ...._........_---------------------------------Distance from nearest building------------------------------------------ <br /> Distanceto nearest lo+ Ime----------- ------ -- - ----------------------------------------------------- '.------------•--------------------------------------------- <br /> ------------------------- <br /> Remodelin and or re airinq (describe):-------------- -- - -- aw, 44?� _ <br /> =------------------------------------------------------------------------- -----------------------'----------------------------------- -- ----------------------------------------- <br /> a E <br /> - ------------------------------------------------ <br /> -------------------------------------------------------------- ------ ---p-• ----------------I------------------------------•-------------------------------------------------`----------------------------- <br /> I hereby certify that I have prepared this application and Arat the work will:be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and, egu a ions of the San Joaquin Local Health District. <br /> (Signed)--------------- ------------------------'-- --- ----------------------- ----------------------- (Owner and/or Contractor) <br /> BY� (Title)...en _ -- ----- - -- -- --------- <br /> (Plot plan, showing size.of of, I ion of system in relafion to wells, buildings, etc., can be placed on reverse si el <br /> FOR DEPARTMENT USE ONLY s ' <br /> APPLICATION ACCEPTED BY---- _ ------ - ------ ------ ------------ <br /> --------------------------= QATIQ <br /> REVIEWEDBY---- -------------------- - -------- -------------- --- ------------------ ------- ------------------------`--- --------- DATE--------- ------ <br /> ----------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- ------------------- - ------ DATE-- -__= -`--------------- ---- <br /> ----------------------------d `j i.- <br /> Alterati s aryl/or recom en ations:______ __. ------ --- -- ----- ---/ --- <br /> 3� - -d � - --------- _ <br /> _z..- ' ----------------------------------------- <br /> -------------------------------------------------------------- <br /> --------------------------------------- --------- <br /> FINAL INSPECTION BY:--------��-- ----------------------------------- Date------l�---�4---l-,S-� --------- <br /> a SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.HaxeEton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California nodi,California'" ` ' Manteca,California Tracy;California " <br /> d. <br /> F.P.CO. <br /> r <br />