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-- ---` --- ------------- `� 1 <br /> --- APt ATION FOR SjiiNITATION PERMIT Permit No. -:212, <br /> --------- -- --- ------------------------------- (Complefe•in Duplicate) <br /> -_-- -. __. _ _.-. . --_---..------- This Permit Expires 1 Year From Date Issued A� Date Issued ./n <br /> a <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 compliances with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.15!- ._-. . ---- �7 '7 <br /> -------_ � /u r <br /> Owner's Name.__ ,.e---------� - -_-- <br /> ' ' .. Phone------ - --- --- <br /> Address-------------- ,f'3l <br /> ------------- ----- --- ----------------------------- <br /> ........ <br /> - <br /> Contractor's Name �i'F---...;V7 /1r Phone <br /> Installation will serve: Residence IR Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .._ Number of bedrooms _°Z--- Number of baths ________ Lot size __-- ________________----__. <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table I-T.0- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loarm ❑ Clay Loam-14 Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (If 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 public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_.E-O�____-Distance fro foundation---Ja�_------- Material __4'1 - -------------- <br /> '9i] No. of compartments--.--.,-----------------Size_�__'Yfi'�sx-%r..___.Liquid depth ..'.1....... ----._. Capacity- <br /> Disposal <br /> a acit <br /> '�7 P Y-••- ------------------ <br /> Disposal Field: Distance from nearest well.X.Q- -.----Distance from foundation___10------------Distance to nearest lot <br /> Number of lines-------_1------------------------Length of each line-- -� -------------------Width oftrench.-4-Y-t-----------_-_------ <br /> Type of filter maferial4/_____----------Depth of filter material.../j'''.-.-.-.--.Total length_/_.0-b___-.___ <br /> Seepage Pit: Distance to nearest well/..-------------Dista nce from oundation----l4X�--------Distance to nearest lot lineT__*_-.___.. <br /> Number of pits-__ -------------Lining material_ . Size: Diameter_._ ------ De th_ --.-_. <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 /> Remodeling and/or repairing (describe)----------L-------- ---- ----------- ----------------------------------------- ------•----------- -------• --------------•--------------- ---------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_._. /�`•- _ � -. -----.� _ � ---------------------------------------------------- - -- ---(Owner and/or Contractor) <br /> BY' E� : -- --- _-------- --------=- ------------------- --------(Title)_) <br /> (Plat pla showing size of lot, Iota ion of system in r�latiort to wells, buildings,eft, can be placed on reverse side).-- <br /> FOR <br /> ide),i,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ---- ------ ------ ------------------------------ --------- DATE.-9_ .r_4 <br /> REVIEWEDBY-----_----------------------------- -------------------------------- ------------------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED-------- -- - --------------------_-- ------------------------------------------- --- ------------ DAZE a <br /> Alterations and/or recommendations:__ - --------- ----- ------------- ---- - --- -------------------------------------------- ---- -------------- \ <br /> --- -•----------- ------ <br /> �� _- <br /> - ------- -------- <br /> ----= ------ / fi--- .-_ --------- --- - ------------------------------------- <br /> ------------- ------ -------- ......................... ---- ------ -------------- - ------------ ------------­------ -------------- ---------I----------- ---- ---------------------------- <br /> ..........1-................ .............. ........... ---- ----------- ----------------- --------- -------------------------------------------- - --------------- -- ------------ - -- --------------------- <br /> FINAL <br /> -- .- <br /> FINAL INSPECTION BY:./ �_ � --------------- Date-- f ~ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maseiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Q•: � , V <br /> Stockton,California Lodi California Manteca,California j � Tracy,California - <br /> E.H.9 2M 1.67 Vanguard Ness <br />