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FOR OFFICE USE'.- <br /> -- - <br /> ---------------------------------------------------- <br /> t­- ermit No. <br /> -------��M------------ ---------------- APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------ ------ <br /> (Complete in Duplicate) Date Issued ?!v�Y16 <br /> ------ ------ --- ------- - <br /> ------------------------------ This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Disfrict.for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------- -q-0Y --------------------------------------------------------------- <br /> ----------------------­ ------------------------------------- <br /> Owner's Name------ ---------.- Phone---------------------------- <br /> f <br /> hone----------------------------f <br /> Address--------------------- 91/ f,--- - ------X17'`- -- —--------------------------------------------- <br /> Contractor's Name-----------------0�--7-wu�-------------------------------------------------------;----------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence partmenf House E] Commercial 0 Tr.ailer Court E]. Motel 0 Other E] <br /> Number of living units: --I----- timber of bedrooms _Number of baths ___1--- Lot size ------------------ ----------------------------------------- <br /> Water Supply: Public system Vommunity system ❑ Private F1 Depth to Water Table 447- ft. 4— <br /> Character of soil to a depth of 3 feet: Sand [] Gravel 0 SaDdy Loam 0 OaV Loam E] Clay E] Adobe 2---Hardpan 0 <br /> Previous Application Made: (If yes,date.,-,------------------I No 2"I"New Construction. Yes aj,'-*N, E] FHA/VA: Yes El 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-----------------Distance from foundation--------------------Material------------------------------------------- <br /> No. of. compartments------- -- -----------Size--------------------------------Liquid depth--------------------- ..Capacity----------------------- <br /> Disposal Field: Distance.from nearest well-----------------Dis4nce from foundation--_-_----- -__- ---Distance to nearest lot line-----------.----- <br /> Number of lines___________________________________Length of each line_.__-_--___.____-._�-----------Width of trench.____.__.____-_----_-.___________-_-- <br /> -Type of filter material--------- 4------------Depth of filter material---------------;?------Total lengt�----------------------------- <br /> See -P <br /> pa Distance to near )isfance up a ion---,--' _ ..Distance to nearest lot line___--`_ _._--_..----------- <br /> Arom fou d t' 4 X <br /> I ...�-& 0 <br /> Number of pifs--7 I- -----------Lining material-^--vc-------"W-Size: Diameter._. Depth---- 11­477��------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundafion­------- -----".1ining material_-,---_-----__--__-.._-----_---------. <br /> ❑ <br /> aterial------------------------------------- <br /> 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well----------------------------------____.-____---._Distance.-Distance from nearest building-------.__.--_-_--__-__-----__._------___. <br /> ❑ <br /> uilding------------------------------------------ <br /> 0 Distance to nearest lot line----- ----------- ----------------------------- ------------------------------------------------------------- ------------------------------- <br /> Remodeling and/or , pairing (describe ------ <br /> --------- <br /> -----------------------------:,---_-.-,.-..-0.-2._-_.-.-.-,.-.-� <br /> -----•- <br /> __ _ - --------------------- <br /> --------- ---- <br /> - - ---------- <br /> ---- ......V7---------------4--------e------ <br /> ------- <br /> ------------------------ ------<7-- <br /> --------------------------------------------------------- <br /> --- -- <br /> - --- ------- <br /> ----- --- --------- <br /> 4 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> .ordinances, Sf4te laws, and rules and re tions of the San Joaquin Local Health District.- <br /> (Signed--- --- -r----- - -------------- -----------------------------------------(Owner and/or Contractor) <br /> BY=--------------------- - -------------------------?-------------------------------------------------------------------------- -------(Title)------ -------------------- .........­........ .­­---------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on'reverse side). <br /> FOR DEPARTMENT USE ONLY 721 <br /> APPLICATION ACCEPTED BY--------- -ll � &'La---- -------------------------------------------------------------- DATE-------/9-14 <br /> /------40V 41,46-------------------- <br /> REVIEWED BY------------------------------------ --- --------- ------------------------- ---------------------------------------------- DATE------------------------:---------------------------- <br /> :---------------------------- ----- <br /> BUILDING PERMIT ISSUED--------------------- ------------------- ------------------------------ --------------- --------------- <br /> 7---------------------------------------------------------------: DATE- <br /> Alferafj s a d/or_recon en atiops: <br /> - -- -----------------7 <br /> ------­-- - <br /> ---------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------ -------------------------------------------------- <br /> -------­------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------1-------1-1------ <br /> ----- ------- -------- ---------- - -------------------------- - ---- --- - -------- -------- ­-- ---------------- - ------------------------------------------------------------------------------------------- <br /> n . <br /> FINAL INSPECTION BY:-- ...... <br /> ­------------------------------ ---------- Date..----------------------------- - --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street <br /> Stockton,CaMOU11i Lodi,California V-1 tj Manteca,CCaliforniaTracy,California <br /> ES 9 REVISED 8-59 3M 3`63 F.F3,1212. <br />