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71 <br /> r APPLICATION -OR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew herein described. <br /> This application is made in compliance with County Ordinance No. 549. wry} Clli4���1c� <br /> / <br /> JOB ADDRESS AND LOCATION--------------4.a�;------l-Z-----------?�.I.ANP____A..QA-V_Tl4A/--- <br /> Owner's Name------------------� <br /> ,z4 /A1s11 / 11�--Ga�2 ------------------ Phone � r7 a <br /> Address-.'-•------- ----------7-•-•-•---- N..........A-,-1C;472-13_*zQ -�----------------------------------------------------------------- -------­---------le------------- <br /> Con -12 <br /> tractor's Name---- ---•-------------- --- ------------------------------------------------------ Phone---------------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ u <br /> Number of living units: ----/__ Number of bedrooms ___Number of baths _'_____ Lot size ____ o X----- _,___________________ <br /> Water .Supply: Public system ❑ Community system FT Private ❑ Depth to Water Table 'L __ ft, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EV Hardpan ❑ <br /> Previous Application Made: Yes ❑ No M' New Construction: Yes Fr No ❑ FHA/VA: Yes ❑ No [ice w <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4. <br /> Septic Tank: Distance from nearest well -„Distance from foundation__-_ _-Q-_-______-Material___ <br /> p _ � - ��IA_k1 c.� <br /> P q p. J,-------------- CapautY f= -------- <br /> -------------- <br /> 12/ <br /> -- ---------- <br /> No. of compartments _- Size__�_x__�__.2�__�'/.___Li Liquid de th_______ _ - <br /> Disposal Field: Distance from nearest well_ 0_f---Dist pce from foundatie,n____lQ__�____-Distance to nearest lot line__/_.__.. <br /> i <br /> Number of lines_1_7�_-P_t---------------LengA ot•each lin , __DAAGAfi.Width of trench---------- _. _-._________ ? <br /> Type of filter material-___ of filter material-----/__S`..____-__Total length------- -- ----__________ "moi <br /> Seepage Pit- <br /> Distance to nearest well-/ ______Distance frog foundation----/0-_-_____.Distance tosearest lot line____�� <br /> Number of pits-------'�.-------Lininrg material-----/--"C-o n_ Size: DiameterrA_C2C- Depth______...----f='- --- ; <br /> Cesspool: Distance from nearest well-------------- __E Vance from foun�ation--------------------Lining material---__-_________________.__-_________ �14 <br /> ❑ Size: Diameter---------------------------- --------D:pth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building____________--------_-_-______.________._. <br /> ❑ Distance to nearest lot line-------------------- -------- ----------------------------------------- -------------------------- <br /> .9 <br /> Remodeling and -or repairing (describe}--------------- Gt1. =----------------------•---------------------------------- -----• <br /> -------------------------------•------------------------------•------------------------------------------------------ ----------------------------------------------------------------------------- <br /> --------- ---------------------------------------------------------------------------------------------------•-------------j------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------•---------------------------------------------------------------- ---------------------------------------------------------------- <br /> I hereby certify. I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I s, d r s and r €ati ns of the San Joaquin Local Health District. <br /> (Signed) ------ . --- <br /> ---------------------------------------------------------- -----(Owner and/or Contractor) <br /> . Ely----------------------------•------------------------------------------------------------ -----------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plain, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------ -- --------------------------------------------------------------------- DATE----------------...- <br /> ---- -------------------- <br /> REVIEWEDBY------------------------------------------------- --------- - -------------------- --- -------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------- ------------------------------------------------------------ DATE <br /> 1 Alterations and/or recommendations--- ---- ------ -+------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- <br /> ----------------------------- <br /> ifi----_-d�------------ --------^--�--- - ------------- -------------- --------------------------------------------------------------G�iiid -- <br /> -- - <br /> ------------- ------ - ------ -- ----- -- ------ - <br /> ----- -----;;i;2D -- U --------- = <br /> --- -------- F________ _ ------- <br /> --- <br /> --- .. _` _�.sa- <br /> j <br /> FINAL INSPECTION . BY:---------- ----- -------------- ----lQ�r <br /> ----•---------------- . Date-------------------- -"�-- --- ---------------------------- <br /> 495AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> I /r <br /> ES-9­2 M Reviseci 1-57 F.P.CO. ` Jf <br />