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rUKUrrlct USE: <br /> - --------------- <br /> - - _ A,Cn <br /> - - - - -------- -.- APPLICATION POR SANITATION PER r'AN, WA.. O. !� <br /> -- - - - (Complete-in Duplicate) <br /> ----- ------------- <br /> Z p <br /> - -- --- ------ - - -- This Permit Expires 7 Year From Date Issued 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 AND L CATIO - _O/ <br /> Owner's Name__ <br /> ame - - - .. <br /> - -- <br /> Address................... -' - <br /> ---- --------- <br /> ---------------- ----------------------------------------------------- <br /> - -------------------------------------- <br /> Contractor's Name - ...-�...... Phone-tcira6/.�7 &BI� <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -�. Number of bedrooms -_ZNumber of baths .1----- Lot size __7.�_-.K.-_I QQ__.-.---.__--_. <br /> Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table.!'? ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date_ ...__-___- - I No) J New Construction: Yes ❑ No�O FHA/VA: Yes ❑ No�T <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.......-___--Distance from foundation._.._-...._.....Material .----_..__......... <br /> O�fiG 0l No. of compartments.-..-..----- -----Size__----.-_---------.."--Liquid depth---._-. .._-_ ----.- Capacity.... <br /> ---------------- <br /> Disposal Field: Distance from nee st well-.7-57...Distance from foundation..�____.Distance to nearest lot line--:�...�--... O <br /> 1K Number of lines- �_).-.-. ._...- .--- Length of each line-- -- 5�.-. Width of trench...24-" <br /> yfl r - --------- <br /> Type of filter material.-- _--Depth of filter material.--.- --U..-_----Total length----- ----._._.-..----._ <br /> I r <br /> Seepage Pit: Distance to nearest well_.- -S-1.mm-.-Distance rom undation...................Distance to nearest Igt line-__5—..-.---..- <br /> Number of pits-04 Lining material-.. .._ Size: Diametere�x- X�o_Depth_&_._ QQR �J <br /> Cesspool: Distance from nearest well ...Distance from foundation........___. ..Lining material-----..---.----- --------------_... <br /> ❑ Size: Diameter- -- ------ ---- --__ --------Depth-....... ---'--..-..._-----------.Liquid Capacity. .......----------------.gals. <br /> Privy: Distance from nearest well . _...--___ _-_._------ Distance from nearest building---..._-.---_---..---_-.....-.--_..... <br /> ❑ Distance to nearest lot line-------------------------'---.._----------- <br /> --------- <br /> �AAA- O 0 <br /> Remodeling and/or repairing (describe):----..62 ,, ,r-----_- - -- - -- -__-_- <br /> s�7=i�---tea- -p. ----- -------------- - -- ------------------ ----- -- - -- - - ----------- -- -- <br /> -- - -- - - --- -- ------------------------' ----------------------------------------------M----------- '-' <br /> I hereby certify th I ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws and ules and re ations of the San Joe yi Local Health District. <br /> Si ned <br /> 19 ) -- -- - - __ - -�-- - --- Jan <br /> Owner and/or Contractor) <br /> By:...----- - ----------- ----- - e --- ------ -- - -------(Plot pl owing size I t, location of system in rela ' n to wells, buildingsc, can be placverse side). <br /> FOR DEPARTMENT USE ONLY 7 <br /> APPLICATION ACCEPTED BY-W.. 'JWWQ------ - - - - -------- ------------ DATE_'� <br /> REVIEWED BY. - -- ------------- -- - - - ---------- -- ...-- - - --------_ ---- <br /> DATE <br /> ---------- ....... <br /> BUILDING PERMIT ISSUED---- - - - ------ - ----- --- -- DA.E --------- -. <br /> Alterations and/or recomme da+ons ------- <br /> ---- <br /> - - - - <br /> � p <br /> - ....... F.YDE. ................----------------- ------- <br /> - --------- - - ------------------- - --------------­­---------- - ------- - - - ...... <br /> FINAL INSPECTION BY:-... e4 Date - <br /> N'J AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ho.olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press <br />