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FOR OFFICE USE: kAPPLICATION <br /> FOR- ----------- ---------- SANITATIONPERMIT Permit No. <br /> - <br /> --------- ----------- ------------- -- - ------ <br />-------------- <br /> (Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issue <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 /> 1 t�s <br /> IS14 U/ A'VZ�T°VY <br /> JOB ADDRESS AND LOCATION---- ------- - ------------------ <br /> Owner's <br /> j <br /> ---------- <br /> Owner's Name-------- 1es�Ls --------L4c1A5------------------ -------------- ---------- --------------- ------------------------------ Phone- - ------------------------------ <br /> / - --- w---------------------------------- ------------------------------ <br /> Contractor's Name--------------------- Phone----------------------------------- <br /> Instailation will serve: Residence �Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> /. ....- Number of bedrooms __a� <br /> Number of living units: ._l . Number of baths _-+?---_ Lot size ------- ---------- <br /> Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table 33 ft. <br /> Character of soil to a depth of 3 feet: Sand gr-G—,avel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (if yes,date--------------------) No R- New Construction: Yes [P'-No ❑ FHA/VA: Yes ❑ No Et <br /> t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v <br /> Septic Tank: Distance from nearest well------ ---__Distance from foundation---,/v----------Material-_____-!qqN1e6rC-----------------_ <br /> No. of compartments..........o`Z------------Size------80_-<> <br /> Liquid depth `1 Z """-----------Capacity---- ------ <br /> Disposal Field: Distance from nearest well__..".-__Distance from foundafion---ZQ-------_-Distance to nearest lot <br /> -------Len Length of each line-----------9- ---------.Width of trench------- -------------------- I\ <br /> 0� Number of lines--...---___��----.--. _-- 9 <br /> Type of filter material-_&Y'_ --Depth of filter material---f$----_-----_-Total length-------- 0------------------------- <br /> Seepage Pit: Distance to nearest well_.___" ----------Distance from foundation---62---------Distance to nearest lot iiri`ra' ----_-- <br /> �- Number of pits r Lining material •t Size: Diameter---- Depths --- F <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------- --------Lining material----------------- ------------- als. <br /> El Size: Diameter ----------Depth--------------------------- ---------- Liquid Capacity----------------------------g <br /> �t <br /> Privy: distance from nearest well._-------------------------------------------- <br /> -Distance from nearest building <br /> ❑ Distance to nearest lot line----- -------------- -------- <br /> Remodeling and/or repairing (describe)------------------1'1404...Jw- ------Va -------------- <br /> ----------------------------------------------- <br />'i I ----------------------------------------------- ------- <br /> - ------------------------------------------------------------------------ <br /> r --------------------- ---------- <br /> ---------- ------- - --------------- ----- ------- -- - <br /> ------------------------------------------------------------------------- --------------------------------------------- --------------- <br /> I I 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 /> �/ - <br /> ---(Owner and/or Contractor) <br /> I (Signed)--���.�"�------------ -- --- - ---- ------- <br /> - - - ------------------- - <br /> ----- ------------------- ----( � ---------- -------- ---------------- -- -- --- --- -- -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., a e placed an reverse side). <br /> FOR DEPARTMENT USE O LY <br /> f DATE` <br /> APPLICATION ACCEPTED BY----- <br /> - ------- -------------------------- --------- ----------- ---- ------- <br /> REVIEWED BY------------- ------------------ -------- ---------: ----------- --------- - ----- - -- --- ------- <br /> ---- DATE------ ------------------------------------------------ ---- <br /> BUILDINGPERMIT ISSUED---- ----------------------------- --- --------------- ---- DATE----------- -- ------------------------------------------ --- <br /> Alterations and/or recommendations-------------- ------------- -- ---------I--------I----------------------------- <br /> l ----------- --------- ---------- ----------------------- ------------- -----------------------•------ --- <br /> ------------ ------------------- ------•------------•------------------ -- -- -- ---------------- <br /> -- ------- -------------------------- - ------------•------ ----------- <br /> ----- ------ - ----- --"- --- ------- ------- --------- ------ -- -- ---- -------- ----- <br /> FINAL INSPECTION BY:.. - - Date ------- --- ---- -------------- --------- <br /> SAN JOAQUIN LOC HEALTH DISTRICT <br /> 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.C C. <br />