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APPLICATION FOk,—ANITATION PERMIT Permit.No,.'-- <br /> k ., 0 (Complete in Duplicate) 3l� <br /> L} Date Issued --_ <br /> ` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> his application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---------- 15,------ ----- - <br /> .f <br /> Owner's Name_ _ <br /> --•-- - -- ------------------ ---�---• ----------- -=_- ----------- --------------------------- Phone- - ? <br /> - ----fly- <br /> aZ�1---- ' <br /> Address == s <br /> t Contractor's Name---='_ ___ — „ hon <br /> - _ --- � _�- -F --------------------------- <br /> - e =-9 7 <br /> Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of liv}ng units: _.J____ Number of bedrooms -a_ Number of baths __/_-_ Lot size ------,-S*Z' X_�c��.______________________-- <br /> ' Water Supply: Public system Community system [I Private L] Depth to Wafer Tablejq_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No D4 New Construction: Yes ❑ No CK FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPEwCIFIQTIONS: ; <br /> (No septic tank or'cesspool permitteck if public sewer i available within 200 feet.) <br /> �Septic ank: Distance from\nearesr wdl--_-___.__-.__-Dist nce from foundation--------------------Material---___.-.--.--__...__._._____..--_-.__.______. <br /> '',� No_ of comparFments `.-.---------------Size -----------------------------Liquid depth--------------------------Capacity------------------ <br /> : Dispos I�ield: Distance from nearest well � � <br /> ____-_..._.Distance from foundation____________________Distance to nearest lot line____.___._.____. <br /> ' Number of lines-------------- -----=';---- ------Length of each line------------------------------Width of french-------------------------------- <br /> Type of filter material-------------'-- ---------Depth of filter material-----------,-----------Total length----------------------------------__--- - <br /> E .fi <br /> Seepage Pit: Distance to nearest welL_ 1�.___Dis#ante from fo nda+ion___l ___.Dist je +o nearest lot line <br /> �.. - <br /> umber of pits_-________.____Lining material-_ ___Size: Diameter_..�s _-----..____.Depth_---_97s.�'________.____ _ <br /> p Nistance from nearewell �^ <br /> Cess ool: D st __ Distance from foundstion___________________ Lining material___--_______________-______---_---_ \ <br /> ' ❑ Size: Dia�ieter---------------------- Depth----------------------- -Liquid Capacity ---- als. <br /> q P Y- 9 <br /> # Privy: Distance f�r6 nearest well--------------------------------------------------Distance from nearest building ---------_---.---------- <br /> ► ❑ rDis+ante to)�e st lot line------- <br /> and4r repairing.(de ribe,h------4 ---- -- ----------------------------------------- ----------- =- <br /> S � <br /> ________________________ ____`___--___---___ ` <br /> 1 <br /> 1 --------------------------------------------------------------- <br /> {{ A <br /> -----------'------------ ---------------------=---•-"--•--------- ------------------"------------------------------- F'---------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin,County <br /> ordinances, State laws, and rules and re'uiations of the San Joaquin Local Health District. <br /> (Signed)__ y` <br /> 9 )` f - ----(Owner and/or Contractor)... <br /> (Plot plan, sho g size o t, location of system in relation to wells, buildings, etc., can be placed on reverse sire). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEP7E D BY -------------------------------------------------- DATE=------ 3 5�� <br /> REVIEWEDBY-------------------------- -------------- ------------------- -------------------•---------------------- DATE <br /> E BUILDING PERMIT ISSUED------=-------=-------------------------------------------------------------------------------------- DATE------------- <br /> Alterations and',or recommendations:-_-----._____. _ .. <br /> -•--------------------------------- - -- H-----•--9_r------------------------------- <br /> ---� � <br /> -------------­------------ -------- -• - - - --- p-1 - ----- - --- ` <br /> ------------------__.- - <br /> __________`___ --------------------- <br /> _---_.___. <br /> fes;. - .�.. J <br /> 1 ` FINAL iNSPECTI <br /> BY ----- ----- --- Date--- - — �— <br /> �Ft <br /> SAN JOAQUIN LOCAL HEALTH DISTRE"I r, <br /> Iti 130 South American S fro ek\ <br /> } 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street <br /> FF Stock+on, Caiifornie Lodi, California Manteca, California Tracy, California <br /> Gds �—.�... <br /> ES-9-2M Revlsea 1-57 F.P.M <br />