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OR OFFICE USE: <br /> / 6S <br /> --- 3-�(- - - APPLICA11ON ,06R SANITATION PERMIT rmi No._.__ - (Complete in Duplicate)1 __-e-f-A _._-__- This Permit Expires 1 Year From Date Issued <br /> Dafe- ed ../l./.... <br /> b <br /> Appliiration 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 4AN!9LOCATION 1 !� ��5 --------------------- ----."`'------------- ----- --- --•---- <br /> Owner's Name . F._... Phone... .... .............. ... <br /> ---••. . <br /> Address --------- w:... .... _........... <br /> Contractor's Nam ....... ----•--- ........... .-:- --------- - -- ............................. Phone. .... ..:.__...--•----•----•--- <br /> Installation will serve: Residence Apartment House ❑ Comrr rcial ❑ Trailer Court ❑ Motel ❑ Other 0 <br /> Number of living units: __/. Number of bedrooms 2.. Number of baths 4, -Lot size .....�.?A - . ------ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ;t� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam qlay4statn ❑ Clay ❑ Adobe g Hardpan ❑ <br /> Previous Application Made: (If yes,date.-__ _.-____._.-) No [Z New Cons*uction: Yes No ❑ FHA/VA: Yes ] No F1 <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_�___f.Distance,from foundation../.Q. _. <br /> -...._ Ma`ter'll(L .' _--__---__. <br /> No. of compartments_._._.__ _.____.___Size'4" �'���� � S.._.Liquid depth-h ----------Capauty'A Q� <br /> T� <br /> u <br /> Disposal Field: Distance from nearest wells ------t-Distance from foundation .490.1......Distance to nearest lot line . � <br /> (� Number of lines.... ___-_,_�._.-+_-_ Length of each line?S 4tr-7-30 Width�f trench �.V~ __.: <br /> Type of filter material-.S° off. _-Depth of filter material------48- --__�_.-Total lehgth_-__.. Z ................ <br /> Seepage Pit: Distance to nearest well-4 _ ______Distance from f undation -6_.�.._......Distan�e to.gearest lot line © <br /> �f Number of pits------3------------Lining material... <br /> - -- .,-'__De`'p _th :-._ 5............... <br /> ___.Size. Diameter ,..3 . <br /> Cesspool: Distance from nearest well.----------------Distance from foundation r`Yining material-_ ...................... <br /> ❑ Size: Diameter-------------------- ----------------Depth--------------------------------- >-----------Liquid Capacity---.- .. - -----•---;--gals. <br /> i <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> F1 <br /> _____ ...______ _-_-_.._-_.-_._-_.❑ Distance to nearest lot line-------- ------------------ -------------------------- -- ------------------------------------------------------------­------- <br /> Remodeling and/or repairing (describe---------------------------------------------- ---------.................... ........ - <br /> .w.... .l-. w . <br /> ---------- ------•--•-- ------------•--------- ................................. .... -- -----•.-------------- ---.x.�.w <br /> ------- --- ---------- ------------------------------------------------ -- ---- -- ---•- -------------------------------------- ---------......_......-••--•---_.. . { - <br /> 1hereby certify that I have prepared this aPphca#wrl and #Ila,#.tble ,prk will be done in iiccordance with San Joaquin County <br /> ordinances, S e law;, and rul and r ulationt of the San Joaquie Local Health District. i <br /> � 1 <br /> (Signed) �' -----•------ (Owner and/or Contractor) <br /> --------------- -. . <br /> ------------------------ <br /> By:.......................................... --• � ---- --------- (rifle) --- ------.. <br /> (Plot plan, showing size of lot, location of systo' in relation it/wells, buildings, etc., can be plac" revery side), <br /> -�=--- ' OL <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYDATE ` '-- ---------- -----••------ <br /> - .---------------------------------------------•---••---. <br /> REVIEWEDBY ------------------------------------------------------------ DATE------------------------------------------------- <br /> BUILDING PERMIT ISSUED--.................... DATE........................................................... <br /> ------------- --------- <br /> Alterations and/or recommendations:... .--- . . ---•- <br /> ------ --------------------- ----. --------- <br /> ----------------------------------------.......................---------------------------------•- - <br /> ------------------------ -----------------------------•-----.- ----------- .................. -------------------------------------------------------------- ----------•--------------------------- •----•-- <br /> --------------------------- --------------------------------- -----------------------------------•--•-•-------------------------................. ----------------------------------.........-----••........... <br /> FIN4L INSPECTION BY:-------f-/--•--•-------- ^' _._ Date------- . -------------------------------- ----- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. <br /> a <br />