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-------- --- <br /> LICATION FOR SANITATION PER Permit No. <br /> (Complete in Duplicate) <br /> ----- <br /> .. _ Date Issued --- - <br /> ........................----------------------- <br /> ---- This Permit Expires 1 Year From Date Issued _1,0 <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 JOCATION........ _F/ 6 0 la <br /> .......... .....t..... .................................------------_---- <br /> ............................................ ......I <br /> Owner's Name-------------`1tL.e_.r) ...........................---------•--............-----...........................­­...................... Phone!' <br /> ...... ....... ...... J-rEll, <br /> Contractor's I .............. .......... ............ . ... ............................................................ ... .......... ........ <br /> Address--------7-/. -1, ----------- -------------_-------_-----_---- <br /> Installation will serve: Residence part ent H se ❑[] Commercial ❑[] Trailer Court ❑[I Motel [] -per rQ V/l <br /> Number of living units:7---. Number of bedrooms #--- Number of baths �Z_ Lot size 2s`- <br /> �m <br /> Wafer Supply: Public system P,//Community system 0 Private [] Depth to Water Table(------ ft. <br /> Character of soil to a depth of 3 feet: Sand C1 Gravel F1 Sandy Loam 0 Clay Loam [] Clay ❑ Adobe E--Hardpan 0 <br /> Previous Application Made: (if yes,clote-----------_--__I No El-' New Construction: Yes ka-`No E] FHA/VAI Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fel <br /> Sept* T nk Distance from nearest well..-I, ..�a nce from ounclation...../0--------Material <br /> N'O', of compartments------------ V, ....-Capacity. . ........ <br /> Lr-------Size....�-­­... .......Liquid depth------------ <br /> field: Distance from nearest wel['7.1.+,_�----�s`distance from foundation..__.roO_ Distance to nearest lot fine..... ......... <br /> Number of lines ---Length of each line--------- Width of trench........-.__,_....7, <br /> Type of filter MaTenal... 4_-_jEe,;epth of filter materiel-.-. ------_-Total length___-_._ Fro_ <br /> Seepage <br /> ength----- <br /> Seepage Pit: Distance to nearest well------------------...-Distarl from foundation.------------------Distance to nearest lot line_......__.....__. <br /> El Number of pits......................Lining material...._. .Size: Diameter-----------------------Depth...................._----------- <br /> Cesspool: Distance from nearest well..................Distance from foundation-------.......... .Lining material___----_----_----------_------ Vl <br /> ❑ Size: <br /> aterial-------_----_----------_------ <br /> Size: Diameter--------------------------------------Depth-------------------------------- --------Liquid Capacity....-------------------..gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building--------------------------------_------ <br /> 171 Distance to nearest lot line-------------------------------------------------------............. ------------------------------------------.........----------- <br /> Remodeling and/or repairing (describe)---- ----------------------------,--------­-­--------- -------------------......--•-•-........----------I............................. <br /> ...........................................................................................................................................---------------------------- ............................-------------- Z, <br /> ---------------------------- ---­---­----•-----------......-----•--._...........-------..................-----------------------------------------­-------------------­------­---­----------- ------ <br /> ---------------- --------------­----........................ --------------------------------------------­................................................­-----........------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. Sfa ws <br /> f and rules and regulations of the San Joaquin Local Health District. <br /> !!P4` <br /> (Signed <br /> ----- <br /> - - <br /> -- -- --------------'---------(Owner <br /> - ------ ---------(Ow n a r and/or C ontracior) <br /> By...---. - .........- _....... <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 <br /> APPLICATION ACCEPTED BY... ..... -- --___ .. ... <br /> DATE <br /> ----- <br /> ... ......... ..... <br /> .......................----------------------- ---------- <br /> REVIEWED BY............................. ---------- ATE <br /> BUILDING PERMIT ISSUED------......-_------_-_------ ...........................r"I", DATE-----------------------..... <br /> Alterations and/or recommendafions:-------4.1—- ?-- <br /> - ----- ----- -------- --Z......... -------­­­­ <br /> ................ .......­. ......... <br /> .........................._............. .........................T.................... <br /> �V......... <br /> .......... ...zy. ................... .............----------------------............................----------------------........ ...... <br /> .......................................................-------------------------------- ................................... .... ................................................................. .......... <br /> ell 1��A/ ............... <br /> FINAL INSPECTION BY:.--------C Date . _---------------- <br /> SAN OAQU,N LOCAL HEALTH DISTRICT <br /> 1601 E.Ha.elt..Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy, California <br /> CS 9 ..VISEO .-59 .M 3-'63 <br />