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�i Y <br /> 5 'iC TION FOR SANITATION PERMIT Permit No. _. - --•------- <br /> (Complefe in Duplicate) 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 Ordinance �N,o. 549Il<t'fe�.JOB ADDRESS ANDhOCATION_ __�'`_ --•a-=--�------�--- �----------------- <br /> a <br /> Owner's Name-n-----?r/,-` r /' _��" --•----- Phone -- <br /> `i <br /> Address <br /> / ; ' <br /> 'Phonei'_­•------------ <br /> ------------ <br /> Contractor's Name-------- --- =''"-- <br /> Installation will serve: Y Residence E] Apartment House ff Commercial E] Trailer Court 0 Motel ❑' Other ❑ <br /> f :_: _ --------------------- --- '---------- <br /> Nurimber of living unitsitl� __' Number of bedrooms � __ Number of baths -_ ____ Lot sized.__-•-� �- __ 4 <br /> Water Supply: Public system ❑ Community°system--0_ Private.❑ Depth to Water Table fm- ft. <br /> Characfier';nf soil to a depth 1 f 3 feet: Sand E] Gravel El Sandy Loam ❑ m <br /> Clay LoaEj" •clay-0M-Adobe Hardpan ❑ <br /> PreviousJApplication Made. j es ❑ No ®� New.Construction: Yes ❑ No ®`_FHA/VA: Yes ❑ No <br /> T-YP-E-OF=INSTALLATION.AND SPECIFICATIONS: , <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> 1 <br /> eptic ank: Distance'from nearest well----------- --Distance from foundation_-- ------------Material_-._----__.----_--.---_._---_----__-----.----_. <br /> � ------'Liquid depth--------------------------Ca Capacity j �l" No. of compartments------ ------- -------Size P Y <br /> r ; <br /> } f Distance fram nearest well____ _. -.Distance from foundation_ __._____.Distance to nearest lot line--- "r____:_. <br /> �� <br /> asp sal; ild: . '' �' ----------- <br /> /_ Len--Length of each line_•---s- "-----•--_-----.Width of trench.---- _` <br /> Number';of lines g g <br /> { r Type of filter material___, � -_Depth of filter matenal_.__�"�-___-----Total len th_____�_ '.___-____.__r__ <br />` 5eepage{Pit: DlistanCe to`nearesf well __.___""""_._._ Distance from,f. ndatian'___ __ ____.Di cyto nearest Imo ire <br /> :. } F. \ <br /> Rurnber;of its Lining material_ . __Size: Diameter ___��__�d .---Deptfi___- Q <br /> ( p ,� - <br /> �._. <br /> Cesspool: Dista'nce' 'from nearest well-----------------Distance from foundation---------------._--Lining material_,.__.______:______.____ ____________ <br /> Size: Diameter ems* - q Capacity ----------: --------9 <br /> f <br /> 'I Depth`- ------ = Liquid Ca °cit als. <br /> ❑ r. Nit ""j�""' �. �__ -__----_______._.__Distance from nearest buMin <br /> Privy: a,r Distance) ,roam„nearest we - g - = <br /> Distance to nearest lot _______ <br /> ❑ :-= ------ ----------- --------- ---------------- ----------------------------------- ----------- .,. <br /> ._ -�-"_.._ --f------ --- ------------------- <br /> describe ---- <br /> Rem�e4in and or repairing ( ]----------------- --- �- ---- <br /> g / p 1 <br /> ------- <br /> -------------------------------•-----------------------------------------------=--:;--------------- ---------------- -------------------------------------------•--------------- -------------- <br /> ------------- <br /> ' f---------------------------------I--------------------------------------------------------------------! <br /> ---------------------------------------------- <br /> r ------------`-.--------------------------------------•------------------------------------------------------------------------------- <br /> have prepared this appl <br /> I 1 hereby certify that I ication 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 /> - nd�orContractor]- <br /> Signed---- -----------{Q <br /> r � TitleJ--------� <br /> i (Plot plan, showing size of lot, location em tem in relation`to wells, bui�dings, etc., can be placed on reverse side). <br /> u <br /> I� FOR DEPARTMENT USE ONLY i <br /> s -APPLICATION ACCEPTED.BY-------------------- DATE----------------------------_- _ -- -- <br /> - - ----- --- -------------------------------------------------- ` <br /> REVIEWED.BY'---- - ---------------- -- ------------------------------------------------------ DATE--------- -_ ------------------- <br /> BUILDING PERMIT ISSUED- ----------------------- - -- --- DATE---------- -- � <br /> - = <br /> 9 <br /> Alterations and/or recommendations:-------- ----- -- ------------------- ------- ------------------------------------------------------------------------------------------------------- <br /> �M --------------------------------------•--------------------•---------- <br /> ------ <br /> ri� --------- ----- --- -- ------- -- --�;�----------------------------------------------------------------•-------------------- <br /> d . <br /> t. �� . <br /> } Date__._ ' <br /> FINAL INSPECTION BY:.. ------ - "--"-----"-------- <br /> SAN',JOAQUIN LOCAL TH DISTRICT <br /> 130 South American Street 300 West,08k Stroet , 132 Sycamore,Streef 814 North "C” Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--4-21x1 , Rovisec 1-57 F.P.CQ. — <br /> I <br />