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-- � FOR OFFICE USE: � � / <br /> -------------------------------------------------- APPLICATION FOPSANITATION PERMIT <br /> Permit No. ...,C_- ..5.. 1 <br /> ------------ <br /> (Complete in Duplicated Date Issued -_•••--••- <br /> _ This Permit Ex fres 1 Year From Date Issued <br /> A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described: <br /> Tow <br /> hispapplication is made in compliance with County Ordinance No. 549. Zwo. <br /> JOB ADDRESS AND ��•�!•`'!LSD.Il-..�-a�l�.li�_�-�I. . -.....---/-I.r----•- <br /> 1'hone./ft'1.6 <br /> Q .F '..hf -------------------- --------------------------------- \ <br /> Owner's Name----------'-- --- <br /> Address--_---------------(.1�? ?. = P'.... - honcv.0C? . <br /> s _...rr --• •-----. <br /> Contractor's Name......... _-----• Other ❑ <br /> i Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ ` <br /> '__' Number of bedrooms :7-!= Number of baths .'�•,Lot size _���--X--•�r�-----•-••-"'•••-----....... <br /> Number of living units: <br /> i Depth to Water Table�, ft. <br /> Water Supply: Public system ❑ Commuriity system ❑ private ❑ p <br /> . Clay [3 Adobe e Hardpan C] `�. <br /> Character of soil [Ito a depth of 3 feet: Sand • Gravel [I Sandy Loam ❑ Clay Loam ❑ <br /> ------- -1 No LJ New Construction: Yes No. ❑• FHA/VA: Yes ❑ No ElPrevious Application Made: (1f yes,date----------- <br /> ' <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> t <br /> (No septic tank or cesspool permitted if public ewer is available within 200 act. <br /> Septic Tank: Distance from nearest well.-/�.-----Distance from foundatiUquid,G�-•---• .Mate�a�_._�..Capaci /�� <br /> p --------Size---- ` -- ' 1 iguid depth,-P�z'- Capacity <br /> No. of compartments---_._. _-- <br /> 1 ,� <br /> Disposal Field: Distance from nearest �!I ' r___De gth offrom <br /> each l nedatio >--- -Wath ofnce ttren hgst o�line. <br /> _-- --..-..- <br /> d Number of lines_-_.----- ' <br /> Type of filter material... /C ----Depth of filter material----,fit "____-------To#al length--...-_---sQ•---------• <br /> i t �- a <br /> f>�......Dis#ante to nearest lot line./-'3..--•---- <br /> Seepag Pit. Distance to nearest well A4V—-•---- Distance from foundation- <br /> Pit. <br /> oundation- --- K <br /> --.---.-Lining material__1PD_ Size: Diameter----... '. .----•---'Depth--.--. 5---•---• . -- <br /> j Number of pits--------/-••- �- -- �' <br /> Distance from nearest well-----------------Distance from foundation-------------------- <br /> LiLining <br /> Capacitymaterial <br /> ..--•----_-----•---...-----gals. <br /> Cesspool: ---------• -------...-•-•. <br /> if -----•-De th---------------------------------------------------- <br /> El <br /> --------------------------------------•------•- -- q <br /> ❑ Size: Diameter----- "---•----------------- - P <br /> nearest building----------------------------------.- --- <br /> Distance from <br /> ' Privy: Distance from nearest well-•---- ------- ------- -------------------•----- -----------•---•---•-------- <br /> � Distance to nearest lot line_-_- <br /> • r-------------------- ------•---•----•---•- <br /> Remodeling and/or repairing (describe):------ <br /> ----------- <br /> ----------------••--- <br /> - <br /> --------- <br /> ----- I hereby certify--+hat I have prepared +his application and 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 /> r . 1 � ------------------------------------------------(O <br /> (Signed]--•-----• <br /> wner and/or Contractor) <br /> - 1.s�y. s <br /> � -- � � � --=-------------- --- --- ------------ <br /> By:-------- �?.�- <br /> - <br /> - (r+lei-.------ --•--- ----- <br /> (Plot plan, showing size of lot, lot ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> �. --------------------- --------------•-------•---------------- DATE..--�--!-fa--- .. -------- --------- ------ <br /> x APPLICATION ACCEPTED BYr C_:-� DATE-----------------------•--------------------------------- <br /> REVIEWED BY_-------------------------------------------------------------------------------------- <br /> -------------- <br /> } BUILDING PERMIT ISSUED--------------------------------------------------------------_._.-..---------------•--- •-.............------------------...................................•...... <br /> A, ..............• <br /> Itera+ions and/or recommendations: <br /> ------------- = ---•- <br /> ----------------------------------------------- <br /> : a. ...�-.- -- ------------�,7­ - ------------------------------- <br /> - ------------------------- <br /> -------- --------- ----------- <br /> Date-.--- <br /> ------- --- � -.�.C- -•- ------�--••---•---------------------- <br /> FINAL INSPECTION BY:... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I • 124 Sycamore Street 205 West 9th Street <br /> 130 South American Street 300 West Oak Srreet <br /> Stockton,California <br /> Tracy,California <br /> Lodi,California Manteca,California <br /> ES 9 GEVIs EI1 5-59 $M 5-61 ATLAS <br /> t - <br /> _ y <br />