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---------------------- <br /> ---------------------- -------------- <br /> --------------- ------------ ---------- ---------- A,7MCATION FOR SANITATION PERI Permit No. ..r' e <br /> ------------------------------------ ------------------- .......... <br /> -------- (Comple+e-in Duplicate) <br /> - This Permit Ex fres y Year From Date Issued Date issued .��?'4 <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../41-wwA <br /> 'Owner's Name--- <br /> 4 --------------- -----------------------*------- ----------------------- <br /> Address_.. .. Phone*2 <br /> -------­-------- ----- ------I------------------------­- <br /> Contractor's Name---- ...el ---------- <br /> ----------- <br /> ----------- ­-­----------------------------------------------- . ...... ..... <br /> Phone­,!;;t,,0-.C1 <br /> Installation will serve: Residence Apartment House [] Commercial El Trailer Court 0 Motel [] Other 0 <br /> Number of living units: -- ----- Number of bedrooms -,.Z- Number of baths--------- Lot size ../I <br /> dtz-c/ .?m-.-•-. <br /> Water Supply: Public system [] Community system'Ej Private 9 Depth to Water Table ...... . ft <br /> Character of soil to a depth of 3 feet, Sand 19 Gravel 0 Sandy Loam El Clay Loam ❑ Clay [I Adobe El Hardpan C] <br /> Previous Application Made: 0f yes,date.-.---.--_.._-_---- ) No PZ New Construction: Yes [I No Ej FHA'/VA: Yes ❑ No <br /> ❑ <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._-_...- <br /> .: <br /> 0 No. of compartments---------- -------­Size.------------ <br /> Material -------- ------ ------------ -------- <br /> -- ------------Liquid depth--------- -- <br /> P I------ <br /> Ca acity......I -------- <br /> Disposal Field: Distance from nearest well...---------Distance from foundation-----/J??(____•Distance to nearest log? �4 <br /> Number of lines line <br /> ---------4 Length of each line-- ----76--'­­W!dfh of-trench.--f+----------------­:_-_-:.. ........ <br /> Type of filter maferial­i2� ....Depth of filter material------ I-----�ofal length.----._. --- <br /> --------------------------- <br /> Seepage Pit Distance tonearest well-------_-------------Distance from foundafion-------............Distance to nearest lot'jine <br /> ❑ Number of pits--- -----:�-•--•-------Lining material---------------------- Size. Diameter--- Depth- -------- <br /> .- ---------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation---.-._.---_--_-- ..Lining material <br /> 0 Size. Diameter- -- -------------- ----------------Depth--------------------------- ........................Liquid Capacity------------*---------------------- <br /> Privy: Distance from nearest well ty------------------------ <br /> ------- __----..Distance from nearest bui I <br /> 0 Distance fo.nearest lot line-------- <br /> ------------------------------------------------------------------ --------­­---------I------------------­---------- <br /> Remodeling and/or repairing (describe)-------------------------------- ----------------------- <br /> -----------­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­ <br /> -----------------------------------I----------I---------­---------------------­ <br /> -------------------------------------------------------------------- ----------------------­­- <br /> ----------------­---------- <br /> ----------------•-----•-------•---------------------- ---------•-----------------------------­-------------•--------------------------------------------------------*------*----------*---------*4------------------- <br /> I hereby certify that 1 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 /> (Signed)--------q--------G-<. -------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:---------------------------------------------- ; - <br /> ----------- ------------ ------- ----------------------(Title)---------------------------------------- --- <br /> -(Plot plan, showing size Of lot,-location of system in relafi to wells, buildings, etc., can be placed on reverse side). <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-.---tj- -----------...............--------------------------- <br /> .....--------------------------------- DATE_.BY -4---- ---------- <br /> --- ---•--------------------------PERMIT ISSUED­...-------------------------------------------------------------------------------------------------- DATE-----------------........----=-------...--._.-.•----------- <br /> -------------------- -------------------------------------------------------------- DATE--- <br /> Alterations and/or recommendations:----••--------------------- <br /> ------- --------------------------------- <br /> �DEPAR�MINT <br /> ------------------------- <br /> ------------------------- ----------------------------------------------------------------------------------------------I-------------- ----I-----------......I-----------I----------------- ----------........ <br /> -------------------------------------------------- ------------------ ----------­------------------------------------ ------------- ----- <br /> -------------------------------------------------------­------------------ <br /> ----­----------------------- ............ ..................-- ------ ----------- -- ---------------------------------------- --------------------------------------------------------- -------------------------- <br /> ---------------------­I-------------------------- -- --------- --------- ---- -- --------------- -----------I----------------I-------------- ------------------------------------------------ <br /> FINAL INSPEC Y- <br /> Date.---------- <br /> --- --------------11-------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazoltori Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California <br /> E.H.92M 1-67 Vanguard Press Tracy,California <br />