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------------------- <br /> ----------------------- APPLICATION %EOR SANITATION PERMIT Permit No. _ -�-- <br /> ------- -------------------------- --------- ------ (Complefe•in Duplicatel <br /> -------------------------- --- This Permit Expires 1 Year From Date Issued Date Issued ------ 2- <br /> j <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 Ordin_,nceu,NQ. 549. <br /> �.-JOB ADDRESS AND LOCATION___._ 33a L <br /> / 1 <br /> Owner's Name---------- ----�-.�la.r/.�_----s�,---C�C� <br /> / l _ ----- --------- ---------------------- --------- <br /> AddressPhone.%3/� �_7f <br /> - v ` anis41 <br /> --------------------------------------------- --•----------------•--------- •------------- <br /> Contractor's Name-------------- --�1 .-____•---•-----• - <br /> --------------------- ------ Phone------. -----• <br /> Installation will serve: Residence +[_Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! <br /> ❑ Other ❑ <br /> Number of living units:,-./____ Number of bedrooms _-__ Number of baths Z.._ Lot size ..... _J <br /> Water Supply: Public system•"❑ Community system'❑ Private ❑-�epth to Water Table S.-ft ' <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sand Loam Cia Loam Clay Y ❑ Y ❑ y ❑ Adobe E-`Aardpar <br /> Previous Application Made: (If yes,date.- ---------------- ) No E?-_­N`ew Construction: Yes C� E] FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well._4SV_` Distance from foundation_A - -- <br /> ----Materiai -----__ +►'A_ <br /> No. o compartments /ar' �r q p ------ <br /> P $ize ,_- '; irG__X•l� Li uid de th-_--5''l !- ----- -_Ca acrt <br /> Disposal Field: Disfance from nearest well-_c�Z=C1�---Distance from fcundafion__1G1-_�____._.Distance to nearest lot line ------ <br /> Number of lines------- ----- ---- Length of each line_. ___Z __ __-------,Width of o nearest <br /> _____.?r line --- <br /> Type of filter mate rial4 Depth of filter material___ .1.9f`_----_Total length--------lS-- -- <br /> Seepage it: Distance to nearest well--_�!?t'f Distance fro f nd tion__-LU_-----------Distance to nearest lot iine__.__ti5-.� <br /> Number of.pits___ ..;P __-.------Lining material ____ �� i <br /> - - Size: Diameter- ---------Depth--- ---�--`'�------ <br /> Cesspool: Distance from nearest well _______________ Distance from foundation---------------._Lining.material---____---_______.-_--.-__ <br /> ❑ Size: Diameter- -- -- - - -- - -- --------- Depth---------- ------------------ Liquid Capacity ---•-- <br /> . <br /> Privy: Distance from nearest-well_._.._------------------__ -- __..Distance from nearest:building ---------- ; <br /> ❑ Distance to nearest lot line __ _ { <br /> Remodeling and/or repairing (describe):...........................----- - <br /> ----- <br /> ----- <br /> - - <br /> -------------------------------- <br /> - ---- <br /> ----------------.----------------------------------------- --------- r <br /> I hereby certify that,l have prepared this.application and that the work will be done.in accordance with San Joaquin County r <br /> ordinances. State laws,- nd rules and re lations of the San Joaquin Local Health District. <br /> (Signed) <br /> - -------- ----------------------------- ------------- ------------ ----------- ----------{Owner and/or Contractor) <br /> BY Title <br /> -----{ )----- ...-------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can -be placed on reverse side). 1 <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY___------ --- -- <br /> REVIEWED --- --- <br /> -------------------- --- - - <br /> ---- ----------------- ---- ------- ------- ------ ----- DATE------------•------------- --- -- <br /> - <br /> - ------------------- -----A• E--------- ------- <br /> k 6 . -----f..-- ..Alterations and/or recommendations: --- --- ------- ----------- ---------------------------------- ----- -------- --------------- <br /> - ------------------ ----- ` <br /> FINAL INSPECTION BY:. d--_ - - Date- ( . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT { <br /> 1601 E.Nozelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California <br /> E.H.9 2M 1-67 Vanguard Press Tracy,California +t <br />