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FOR OFFICE USE <br /> _..l/ '?�>_ __. APPLICATION FOR S�ANITAVON PERMIT Permit No. .� �..�....1_ <br /> ---------------- ---/-��} (Complete in Duplicate) Date Issued _ _ _ <br /> lam\ V`-- - --- -- - - - -- <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 work herein described, a <br /> This application m dein pliancee with County Ordinance No. 549.• � '� �� J <br /> JOB ADDRESS AND LOC ON �! Q4�'_ ff ..� ._, e7 461 <br /> Owner's Name 1ae1�'° QB- `` -------------------------------------------------------------------------------------------- Phone------------------------------------ <br /> Address , <br /> -----_-----".e! <br /> Contractor's Name ------- / --------------------------------------------------------------------------------- Phone......................... •-------- <br /> Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: _4--- Number of bedrooms / <br /> ,�... Number of baths _�__ Lot _______________._.___.._._______ <br /> Water Supply: Public system ❑ Community system ❑ Private (jI,- Depth to Water Table _&';�lft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pro"Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/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 /> __.__.Maur al_ _ __ <br /> Septic Tank: Distance from nearest well__��__.___Distance from foundation____�f� �_______________________ <br /> No. of com artments_-_ ��O__.-__Liquid depth___ <br /> P �-----------------Size. ------ X_ <br /> -- <br /> Disposal Field: Distance from nearee -------Distance from foundation--/ ........Distance to nearest lot line._O_�-'..... <br /> Number of lines----- -Length of each line____ <br /> P7�'-------,;�-------------- 9 ------------------------Width of trench--,r�------------------------------ <br /> Type of filter material,/._ Ag.�;eDepA of filter material__/._ -f______Total length •--- .�.1_E_y._'._ <br /> �r <br /> Seepag�.Pit: Distance to nearest well_�`.�__._._Distance from foundation_..... <br /> . ....... <br /> __.Distance to nearest lot line--J—'F___._ <br /> [d�j/ Number of pits_. _____.__._.__Lining mate ria lF f,1 '_-Size: Diameter_ ' ._.-----Depth , '�/ !._ <br /> Cesspool: Distance from nearest well----------_------Distance from foundation-----------.--------Lining material-----------._.--_---._-.--_.____--__ <br /> Size: Diameter------------------------------------De th----------------------------- <br /> ❑ P -- -----------------Liquid Capacity- --------------------------gals. . <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__--____--.___._.__.___-_-____. <br /> ❑ Distance to nearest lot line ------ ------------------------+-'-----------------------,-�----------------•-------------------------------------------------------- <br /> '0 <br /> / <br /> Remodeling and/or repairing (describe)------------ s_ ------ ---------------------••------------------------------ r <br /> ---•------------•---------------------------------•---------------------------------------------------------------------------------------------- ---------------------------------------- <br /> -------------------------•--------------------•---------------------------------------•--------•-------•---------------------------------•---------••--------•------------------------------------------------------- -------- <br /> -------------------------- ------------------------•----------------•--------------•----------- ------------------------------------------------------------------------------------- ----------•----------------- <br /> - <br /> I hereby certify that l have prepared this application ano`that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--------------------- ------------------ -------------------------------------- ---------- {,,tor Contractor) <br /> . .. ( )- <br /> BY:---------------------------------------------------------------------- ------ •-`�-�'• �-------------------------.Title - -.r�e�<'.-- --------- - <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- �------ -K. ----- ---------------------------------------- DATE-----.._�__, .2­­/­­­`-"_6-.------------------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------- ----------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------ ------------- DATE-------------------------------------- ------------------ <br /> Alterations and/or recommendations:--------------- <br /> ('--:----------- ---------� -------- <br /> ---------- -5 c�% r fir —'. s- 'C' <br /> f � <br /> ------------------------- ----------- ------- ------ ------_--------------------- ----------------------- ----------------------------------------------------------------- ------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.......4tK--rSAN <br /> -- ------ Date------ <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> J601 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.CO. c <br />