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FOR OFFICE SE: <br /> _ _____ APP (CATION FOR SANITATION PERMIT Permit No. .....3.. . <br /> --- <br /> :/ -'-F` --- -- (Complete in Duplicate) <br /> Date Issued <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 the work herein described. <br /> This application is made in compliance rrwith County Ordinance No. 549. <br /> JOB ADDRESS A LOCATION Q5•- .. ............................ <br /> 2� <br /> Owner's Name... ........- -•---••-........................................................................... Phone---R-0-•-390--3.9 <br /> Address............... .`�- .......94.... ,.....,...._.................................................................................................... <br /> Contractor's Name----. -•--------------------------.......................................... Phone................................... <br /> Installation will serve: Reside Apartm w o-'use Commercial ❑ Trailer Court [-] Motel ❑ Other ❑ <br /> Number,of living units: __ -_._ Number of bedro __�oms _._I.Number of baths ILot size _ _____________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 5,�7 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: llf 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 publicsewer is availole within 200 feet.) <br /> Septic Tank: Distance from nearest well_____-___Distance.from foundation____1_(�_________.Material_.__.C�7_N.�....................... <br /> No. of compartments �, Size__,S. ?�= _. _�_Liquid depth Capacity...$L?0 <br /> J* <br /> Disposal Field: Distance from nearest well______Distance from foundation......1.U_......Distance to nearest lot line........... <br /> Number of lines...........,(_.....................Length cif each line___________,0.___._____...Width of trench.__.. <br /> Type of filter material-_-1RD�_____,_ Depth o -filter material___.__-/_.9__"_.___Total length,__.____.__9,0_______________________ <br /> Seepage Pit: Distance to nearest well---.�,_ Distance from foundation___._ Distance to nearest lot line..... ........ <br /> .10 <br /> ts______._. <br /> f o <br /> Number b <br /> um <br /> � <br /> NI .p' /-----------Liming material....gpeJe,�----Size: Diameter.......3_3.........Depth........oZ.,j ............. CIA <br /> Cesspool: Distance from nearest well.....____________Distanee-fr©m foundation--------------------Lining material..................................... <br /> ' <br /> ❑ Size: Diameter--•-----------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well.----------_------------------------------_-------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line.............................................................................................................................................. <br /> Remodeling and/or repairing (describe) x - ---------•-----•-------•-------•................•----••--•-•••-- .... _._._...--•---. <br /> ..............................................---------------••--••••-•-•••-•••-••----• ••--•-•••--••-•• - ••------------------------------------------•--------------------..... ............................ <br /> -------•------------------•-----•-----------------------•------•-----------------------------•--*.-•-.--------------------•--------•------•--•------•-------------------------•--------------•---•----------•---------•------- <br /> -----•---------------------•-------------------.•.----------•--------------------------------------------------------------------------------•---------------•------------------------------- •••-•---•--•------- -------- <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, Sfat ws, an rules�,_Jegulafloni' of th San Joaquin Local Health District. <br /> (St ned <br /> �9 ) ••--•---- - - ----- �-------....................................................(Owner and/or Contractor) <br /> By-------- ......i..... - •_••• •--- ............... -----------------------------------------------.........................(Tiitle)----•------------------------------------------------------- <br /> (Plot plan, showing size of to to tion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED r.- � --•• ----- ---- - _ �.. ._. ..�.. : DATE- 1-� <br /> -DATE..,..Z— <br /> REVIEWEDBY-F•••--••••-----••-•---••-••••------ - ----------------------------------------------------------------................... DATE-------------------•--•---------.......................... <br /> BUILDINGPERMIT ISSUED------------------------------------- •-------------------------•--------------------------------•-• DATE.....=....................... --------...................... <br /> Alterations anA/or recom endations--------- ---- ----- ------ - ....---------__________...._- •- <br /> r �� A <br /> --- -------------•-•----•-•• --- ---•------_..._.__•----•• ------ <br /> FINAL INSPECTION BY:--- --,, ` -. -------------- Date------ --- --•--Z-.....----------- ._. .......................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-89 2M 5-61 ATLAS <br /> } s r <br />