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n <br /> .... . ............. Af•, -ICATION FOR SANITATION PERMI I Permit No, -k%_----------- <br />` ..... (Complete-in Duplicate) <br /> This Permit Expires I Year From Date Issued ----Date Issued .-Wil_✓ -- <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 No 549. <br /> JOB ADDRESS AND LOCATION_,.,.:. .-' <br /> -9p-- <br /> / - -x-� <br /> - ------ <br /> Owner's <br /> -------------------------------- <br /> Address <br /> -- <br /> Owner's Name --' Phone- <br /> '--------'------- <br /> Address__ '' <br /> ----- ----------------------- <br /> Contractor's Name-'-- t ------------------------------------ Phone <br /> ------ ------ --------- <br /> I r <br /> Installation will serve: Residence 2�Spartment House E] Commercial El Trailer Court L1 Motel ❑ Other El_! Number of living �_units: f-_-- Number of bedrooms _— _ Number of baths _ -.- Lot size � <br /> -.- f- <br /> ' = <br /> Water Supply: Public system ❑ Community system ❑ Private r®--depth to Water Table Wil'-ft <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ] Clay Loam ❑ Clay [1-Adobe E] Hardpan E] <br /> Previous Application Made: (If yes,date-__ _________ j No 0;` New Construction: Yes 21—No ❑ FHA/VA: Yes = Na ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet-) <br /> Septic Tank: Niostaof nom artments}-well pleance from foundation--__ _- Materlgl - r -_-_---- <br /> P frorn <br /> F <br /> p - � �= 4 Liquid depth_ .. - -------.Capacity,/'-_Z_Z�, z w <br /> �� <br /> Disposal Field: Distance from nearest welL �'.-._.Distance from foundation-,o" to nearest lot line--..-j <br /> Number of lines ----_ - __ •Length of each line-4d.0--- �..` <br /> _``-----------Width of trench_.2_'e <br /> Type of filter material---.-- DEpth of filter material_...f_ ° Total length---- -`_ <br /> --------------- <br /> Seepage <br /> -------------- <br /> P g p g ,� t lot line--'' �---- u <br /> See a e Pit: Distance to nearest well--le- _--~----Distance from foundation---=sem___--_----- Distance to nearest <br /> Number of its___•:___-..............Linin material_ �,� Size: Diameter.-21; ---�O--------- Depth__ J_ - <br /> Distance from nearest well -_---_----..-_Distance from foundation... ............. ..Lining material--.- .-_-__-_-------------_-____ <br /> I' ❑ Size: Diameter- -- _-__--. Li uid Capacity <br /> I •. <br /> I Depth - --------- afs. <br /> Privy-, Distance from nearest well_._-_----_-__--------------------- ......Distance from nearest buildin ' <br /> ❑ Distance to nearest lot line "------------------------ - ------------"--------- <br /> ----- - ------------------------------------------- i <br /> r- : - '-r� - ------ -------------------- <br /> Remodeling and/or repairing (describe):-_.__----- ' <br /> --------------------------------------- -------------------------------------" --------------------------- <br /> -U <br /> ------------------------"---------------- ---------------------'--------------------- ----- <br /> ------------------------------------------------ <br /> --------------------- ------- <br /> -------'------'-- - ------------------------------ ------------------------------------------------------------------------------------------------------------ --------------------------' ' - <br /> 1 hereby certify that I have prepared this application 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 /> (O <br /> (Signed)------------------------- -------- aF1 <br /> 13 --------------------------------------------------- <br /> e��or Contractor) <br /> i <br /> �-- Y- ---- - ------ ----- ---------- "------ --------- - a ' <br /> Title <br /> Plot Ian, showing size of lot, location of system in rhe Ion to wells, buildings, etc., can be placed( p g Y r l d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 1 <br /> APPLICATION ACCEPTED BY .,_ _ �-3" .. <br /> F-21 <br /> - '`Y'- -- ---" -'-'- - -"--'--'----------- -------------- - DATE---�-�---�--�-- �--------------- <br /> '-'- - '- - <br /> --------------- <br /> REVIEWED BY --------------- ' ------------- ----- DATE---- ---------- --- <br /> BUILDING PERMIT ISSUED-------- ------ --- ----- ---------------- -- -".......... -------------- ---------------------------- DATE----- ----- <br /> Alterationsrj ..... <br /> and/or recommend ations-------------------- -- <br /> ------ ---- - ------ ---------------- <br /> ------------­----------- <br /> --------- ---------- -- ----------------- ------------------ ---"--------- ----------------- -- ------ <br /> -' ' - -- <br /> - ' <br /> --- -- ----- -F <br /> FINAL INSPECTICt.f BY:_. .. _--_-.-._ Date_. ... r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> S-locklon, California Lodi Colifornic Manteca, eoli?ornla .racy, California <br /> 4 I.N- 9 2M 1-67 Vcnguart Press <br />