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rVK vrrit-C uJC: <br /> t�------------ ------------------ = ' "` <br /> p .- " A: ICATION FOR SANITATION PER�� ! Permit No. ., .................... <br /> ------------------------ <br /> (Complete in Duplicate) <br /> - -------------- - Date Issued - ----f_, . <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to conruct a install the rk herein described. <br /> This application is made in compliance' rytyrdn ��r^ <br /> �`" (J'� �' 6✓�c�' Ql� ------------• ------------------------------ <br /> JOB ADDRESS AND LOCATION <br /> Owner's Name-----------------SL_ f'rr` ------ -- - -------------------------------------------- -------------- Phone <br /> Address---------------___-••---.r� <br /> i� . --------- <br /> -------------------- <br /> -----•- . <br /> iI Contractor's Name............ Phone dl� _pllQ 7 <br /> Installation will serve: Residence [Apartment House ❑ Commercial'❑ Trailer Court ❑ Mot 1 ❑ Other El <br /> CNumber of living units: __f___ Number of bedrooms _ _. Number of baths ___/___ Lot size __-- -- -----Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-_ ft. <br /> �. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [g-"T-,lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------1 No [;;_�lew Construction: Yes-.E] No ❑--1FHA/VA: Yes ❑ No [3— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -i_Distance from foundation__ ----------- <br /> _Material_---' � __ _ .---__.___- <br /> Septic T nk: Distance from nearest weH__��.__ �j,3____.___ . � ______._. <br /> (� No. of compartments______.------------Size---6_&_ _..Liquid depth_.._.; _._________Capacity___&�04_______--- <br /> Disposal field: Distance from nearest well---_ . .___._Distance from found ation_I5;__ -------Distance to nearest lot <br /> Number of lines-----------/---___ .___.____-__Length of each line......19f?-_`________------Width of trench­rPAIL�--------------- <br /> Type of filter material--- g si <br /> �� <br /> De th of filter material-__ ______._.Total len th______ _ _______________•__--_.---__-_ <br /> See pa rt: Distance to nearest weII-11V___ ______Distance fr m foundation__Ar0___-.......Distance to nearest lot line___30925V <br /> [ Number of pits-------- -----------Lining material- Size; Diameter.__ '---------Dep th__�r"' ------------------- <br /> Cesspool: Distance from nearest well----------_------Distance from foundation--------------------Lining material__.______.__---- ___.____________- <br /> ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity------------••-•-----.------gals. <br /> Privy: Distance from nearest well----------------------------------- from nearest building------------------------------------------ 0 <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------/� <br /> Remodeling and/or repairing (describe):--------- - � — .5'. � <br /> ----------------------------------------------•---. -----•--•----------------------------------------------.------------------------------------------------------ ------------------------------------------------ 0 <br /> •-•-----•----------------------------------•--•-------•---••------------ <br /> ----------------------•-------------------------------------------- i <br /> ' ----------------------------- --------------------------------------------------------------------------------•---------------------------------------------------------------•---------------------------------- <br /> 1 hereby certify tha - <br /> t'.) have prepared this application and thot;the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and regulations of the San Joaquin Local Health District, <br /> r--'7 <br /> (Signed)--- ---------------= f,.�'. _ = Own and/or Contractor) <br /> By: ..--!-"' --------•----------------------- ----(Title)-------- -- <br /> 1 (Plot plan, showing si:ce o lot, location of syste In relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------- - - =------------------------- -- ---------------------------------------- DATE----- ---------------------------- <br /> REVIEWEDBY--------------------••----------------------------------------------------------------- -------------------------------------- DATE---------------------------------------•-------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------- <br /> Alterations and/or recommendations:-------_-----------------________-____._____._.-___ <br /> --------------, --f-1_�_ ------�'��`� � ------------ -------C� -------------------------- <br /> ------- ------ <br /> -------- ----------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------ --------------- ------------- <br /> ----------------------------------------------------------------------------- ----------. . . <br /> F -- <br /> -------- <br /> ---------------------------------------- ---- <br /> ---------------------------------- ------ - - --------------------------------- ----------------------------- ------•---------------------------------------------- -•---- ` - <br /> -------------------------- <br /> FINAL INSPECTION BY:------...11:1__. --------------------------------- Date--- ----- ---- -----k4_--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />