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FOR OFFICE U�,E:� <br /> ------ -------- -- APPLICATION POk SANITATION PERMIT <br /> Permit o. ....................... <br /> ------ - --------_ ........... ----- ----------- - <br /> -"--------.-----.--- (Complete-in Duplicate) Date Issued <br /> ---------- -- ----- -' - ---;--------------'------- <br /> ---Th'is-Perm it-Ezpires-1-"Year Fiom•Date Issued � <br /> Application is l ereby made to the San Joaquin Local Health District for a permit to construct and install hework herein described. <br /> This application is made in compliance with County Ordinance No. 549. , a <br /> R <br /> ------------- <br /> JOB ADDRESS AND LOCATION_--__ 1I. _>= NR� a :_.:..�_�- S---- - .. <br /> Owner's Nam'e--------- - �p M - ... . -�-� ------------------ ------ Phone-- <br /> Address--------i.............J <br /> fid i�1- N1.L A—V E---------- ------ <br /> i <br /> Contractor's f Name---- N- ~------------------- ------- --------------- ----------- ------- - ' -------------------- --------Trailer <br /> ------ Phone <br /> ------ ----�f-------•- <br /> � lel <br /> Installation will serve: Residence ❑ .Apartment House [I Commercial ElTrailer Court `Motel Other <br /> x'TNumber of living units: __ ----- Number of bedrooms ----- Number of -aths ........ Lot size .____ '+-------._._-----._._---__.-- .-_-___-.--._ <br /> Water Supply: Public system ❑ Community sys ❑ Private Depth to Water Table 0-i <br /> 1 <br /> Character of sail to a depth of 3 feet- Sand Gravel ❑ Sand .Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Ilf yes,date_-.-------- 1 No New Construction: Yes ❑ No �HA/VA: Yes ❑ No I3� <br /> ,AND SPECIFICATIONS:Y. <br /> OF_INSTALLATION .. -_.. _�._.....�. __� - , <br /> ,. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well -_-_-Distance from foundation--------------___-.Material ____._._.-__..._..-_-------.-.._._.---..._----- <br /> .Capacity <br /> s,)qs"rf AhG No. of compartments----------- -- ----- ----Size---' • - ------ -----------Liquid depth--------- ------- -- - -' --•-------------------- <br /> Dis osal Field: Distance from nearest well Distance' f4 m foundation-_..__-------------Distance to nearest lot line______....-..____ <br /> p �- <br /> �,.Q1ST1 Alice --- <br /> Number of lines------------'-'---'----- -------Length•of leach line......-------------------------Width of trench------'---'-----.----'---------'--- <br /> Type of filter material__- -------------------Depth o-f-filter material-----------------------Total length----------------.------------------------- 1¢ <br /> -.-. ""rDistance to nearest lot 13ne__ ._..______ <br /> Seepage Pit: " Distance fio nearesf well .--.-Q .._-- D`is}ante from foundation__ <br /> ,l� Q_.i}epth. . � <br /> " Number,of pits �.�",_-.;Lin ng�matenaL Q --_ Size Diameter - - :------ _•••• . <br /> ; . ---...Lining mate`'rial � ti <br /> Cesspool..--4._...._—Distance�fi'om.,nearest wet! .. ... .........distance�rom foundation -'--- -------- ------- <br /> -- -- <br /> Size: Diameter. -- ... D,epth,Y_.. -�' f -=- - ------....Liquid Capacity ' gals. <br /> ❑ �. ti 6 <br /> Privy: Distance from nearest well---- -------------- ---------'----__ -=`......--Distan`ce from nearest building----.-_'--------'---.------------------_-. <br /> ❑ Distance to nearest lot line ' ' I ' �.', ----------',1-------------`--------------------------------- ------------------------------------ <br /> ' Remodelingand/or repairing ............ f- __._:_:t _-.- <br /> • - k•'Fes!¢-U-' ''' ' ------------------------------------------------------ <br /> t # ------------------ ------------- ' <br /> ------ ------ <br /> - : ' - - fi - <br /> • 1•� .�..—-• <br /> _--_.--------------------------Y__-_--_.-.-_._-._-_--_•_-_v_c_..__------_ _._.______._ <br /> I hereby c ify that I have prepared this application and.tha+.+he-w6rk will be done in accordance with San Joaquin County <br /> ordinances, at law , ands s anegulations of the San Joaquin local Health District. <br /> ► ,, <br /> (Signed} <br /> ,�r <br /> �%1 ` 1_ f_ Q._.. 1-�f?Q _ }l (Owner and/or Contractor) <br /> (Title)-- .............. .......... ....... <br /> y•---- ------------.-----------, <br /> (plot plan, showing size of to+;laaiicnwof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-------- 1. r - --------'............ ''--------------------- - -"--------- DATE- / rJ --`------------- <br /> REVIEWEDBY---------------------------------------------------------------------------- ------ --- DATE <br /> BUILDING PERMIT ISSUED---------- - --=----------------------------- - <br /> "`- ---------------- DATE----------------------------------' <br /> and/or recommendations:------- --------- ------------------ <br /> Alterations <br /> r -----______------------------------____ _______________ ---- <br /> ..........................-------------------- ---------_-'-•-...r..______----.i -----------"- --------------------------------------- -_--------- ----------•'__. -___._ <br /> --- <br /> t�1 �._i_ ``I {-.j`�--------------'----------•--------------- ----------- -- --------- ------------------ <br /> -----'- -------------- - ---- <br /> FINAL INSPEC :. fes Date ... l l = ' ' ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Flasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />