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1 Il-L <br /> GG <br /> ----------- <br /> ------ <br /> --------------- ------ ------------------------------------------ APPLICATION FOIL SANITATION PERMIT fo <br /> ------------------------------------------- -------- Permit No.��J <br /> r <br /> i (Complete in Duplicate) <br /> --------------- This Permit Expires i Year From Date,Issued <br /> 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 with County Ordi c No. 549. <br /> JOB ADDRESS AN C TI N_i•_�_ ,� <br /> I <br /> Owner's Name----- ------ -------- ------•--------------------- <br /> ---- <br /> Address-----------•-•- ----- -- - --- - <br /> P e. _ <br /> -------------- <br /> --------- <br /> =� ---- ----- <br /> Name.._______ .�.� � ------- ---------­ <br /> Contractor's <br /> .� '- <br /> Installation will serve: Residence A artment House Commercial . I' -- Phone..__. <br /> t p railer Court Motel ❑ Other [] <br /> Number of living units: Number of bedrooms k <br /> --__ ._ Number of�baths ._� � __ __ <br /> �,- ,�� _,,�._ _.vi Lot size ----- '`` t�C . <br /> Wafer: Supply: Public system ❑ Communit system h <br /> Y Y ❑ Private Depth to Water Table >� ft. <br /> Char 1cter of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam'r Clay Loam ❑ Clay Adobe <br /> Previous Application Made: {If yes,tdgte__.- } ►�o -- Hardpan ❑ <br /> ❑ New Construction: Yes ❑ No , FI{A/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic"taWor cesspool permitted if public sewer is available wifhin 200 feet.) r <br /> Se I <br /> Distance from newest well-_.--___-_-. "_Distance from foundation-_.__-._ <br /> ` --" Material <br /> �9* No. of compartments------ ---- ------ <br /> Size------------------------- .Liquid de th__._. -~-Ca silt y' <br /> D' .._ p Y - --------- <br /> F Qistar ce from nearest wel1-_I_p-_--_- -_Drstance from found3ion. �- <br /> -..Distance to nearest lot line"___ i <br /> Numbar of lines ,,, �� ��__.� <br /> Length of each fn ..�___-_" -_--__---Width,,of�trench <br /> Type fol filter material_ `1 �i-G-.-__- <br /> �.--Depth of filter material-------y w.<< ,. ' J' .• ------ <br /> ` .; Total length-------- ----------rad � .. <br /> Seep lge Pit: Distance to Weare t well_ __ e` f t <br /> I 1400.E--_Distance from founds#ion-_----_:'�`©_ Distance to nearest lot line_..Ile_ <br /> bier of pits-=-_ .--------.------Lining material_ 6r-_-- <br /> t� I <br /> size: Diameter-Z-3- _Depth._ ��_ <br /> Cesspool: Distance'-omnearrest�well'" _._:p' is�t"a ce.r{ro oundation. <br /> ••ulw,,1006 ►'Lining material. <br /> ❑ Size: Diameter.___:.__ R` <br /> i - y Depth-_ ---------- L� uid Capacity- <br /> ,G p Y gals. <br /> Privy: Distance from nearest well------------------ -------- ,, <br /> Distance-- from nearest building--------------- ----------- <br /> IF � <br /> Distance to nearest lot line------ -------------------- <br /> Remodeling and/or repairing (describ'e):----------- --- __ � #I�{,� �^ ' <br /> 1 <br /> ?,r 'S <br /> __ _::: �__ _:. _ --------- <br /> - ; <br /> ---------------- <br /> Ihereby certify than I have prepared thi <br /> ordinances, State Laws; and rules and ; syapplicafion and that.the work will be done in accordance with San Joaquin G`Oun+y <br /> regulations of the San Joaquirr Local Health District. <br /> (Signed)- <br /> ------------•-------- -------- -( <br /> BY� ` -------------(Title)--------------------------------- <br /> (Plot Con f <br /> +rac or) 1 <br /> plan, showing size of lot, locationtof system in relation wells, buildings, tc., can be placed on reverse side). <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBY .---".'_____________ Q <br /> = DATE . __ <br /> REVIEWED BY.. ----- <br /> ------------------- --------- -----�----- ------------------------------------------------ <br /> ---- -�---�-� ------�- ---�----� --�-- <br /> BUILDING PERMIT ISSUED - - ` DATE t <br /> . � ----------------------•---------------- <br /> -------------- <br /> DATE. <br /> aerations and/or recommends+ions:..-.°__�_..�_��' �""� .-- -_ � - �---�- " � -----------------_.-_". <br /> ------------------------------------------------------------ . <br /> -------------------------- <br /> ---------------------------- <br /> =------------------- <br /> ---------------------------- <br /> - ----- <br /> FINAL INSPECTION BY:- , <br /> ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. `300 West Oak Street <br /> 1 124 Sycamore Street <br /> Stockton,California Lodi, California 205 West 9th Street <br /> F.P.CO. Manteca,California <br /> Tracy,California <br />