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FOR OFFICE.US
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<br /> . ........... ......:.......... APPLICATION FM SANITATION PERMIT Permit No. .,��� �....
<br /> ...... ...........,. (Complete in Duplicats)
<br /> D to Issued ..__.. , _. .
<br /> .......................... This*Permit Expires I Year From Date issued
<br /> t d 17 0'-03
<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 epp�tine ,.is_rnade..in.cornpliance,with County Ordinance No. 549.
<br /> JOB�ADDRESS ALOcATIo ... ? ... ...... ... . .... .... ....._....._...._..:....... .......
<br /> OwnersName... .. ...................... ._ .. . _.«.«_._.......,.,.......».. ..,....,..«_.,..............,_.......... Phan _.._..�-•----�--.._......
<br /> Address---.. . %"T 'z- -' ...... -- . .._.,......._._.........,....»...............................»......_ . —.......
<br /> Contractor's Name.....»_,».....,..r. r .. ......o. .,,,._............. ....I....................... .....
<br /> Installation will serve: Residence 5f Apartment House ❑ Commercial [j Trailer Court ❑ Motel ❑ Other ❑
<br /> Number of living units: Number of bedrooms Number of ba,hs" . .. Lo, soca _..._-......-- r�
<br /> Water Supply: Public system ❑ Community system ❑ Private g Depth -o water Table 12rIf.
<br /> Character of soil to a depth of 3 feet: Sand n Gravel ❑ Sandy Loam 9 Clay Loam ❑ Clay a Adobe I3 Hardpan ❑
<br /> Previous Application Made: (If yes,date -1. ....1 No ❑ New Construction: Yes ❑ No a FHA/VA: Yes LWI No
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> ( o septic tank or cesspool permitted if public sewer is evag"within 200 feet.)
<br /> t" Distance from nearest well...... ....... ..Distance from foundation....................Materiel...._..............
<br /> _..._._......:w..... ... ^�
<br /> No. of compartments.... ..._---.-.---.'._._Sixe................................Liquid depth:_..._............._..-._-Capacity..................
<br /> .,�
<br /> Disposal Field: Distance from nearest well-,.-.-... Distance from foundation-4.0.........Distance to nearest lot line... ...:... ,
<br /> Number or Iines....,.... .y-., -... Length of each line...... L7......_.��.....Width of trench...._., _r .........
<br /> rr Type of filter material..:�.r..-`Wj&_ek_Depth of filter material.......49-.......Total length__._.-....__....-_.'.--_.,,��.�.�-.....�.
<br /> Seepage Pit: Distance to nearest well...._.-•..............Distance from foundation..._...._............Distance to nearest lot
<br /> / 0 Number of pits, __................Lining material...............-.......Size: Diameter.....--.......... . ...Depth-..........._._..«.............
<br /> Cesspool: Distance from nearest well.................Distance from foundation.__............_._Lining material-......,.......................
<br /> ._...
<br /> [J Size: Diameter_.........•.........„.....:_.....Depth .» ._.._.__.......»... ..._Liquid Capacity....., ........... ...gals.
<br /> Privy: Distance from nearest
<br /> ,well...„...«............._.........., Distance from nearer, building........ ..:
<br /> ❑ Distance to nearest lot lino............._...-..._ ----- ...«_--.--_.....«_ ..,... j .... ..........»........ ... ...w�.....». ....
<br /> 'Remodelling and/or repairing (describe):`_. -,.............,........__......................................... ........ ...........................».........,.....,....,..».»..
<br /> + a
<br /> a ;'...._....................»»..........__....-...«...............................,.........................Y....................,..,»..w.,..........,.. ...................»..._..-...,.............-...........
<br /> _...._
<br /> „_
<br /> I hereby ertify Haat I have prepared this application and that the work will be done intaccordance with San Joaquin County
<br /> ordinances, t e laws,end les an egulations of the San Joaquin Lecal Health District.
<br /> (Signed)... ...... . ............:... ................ ....... .._....-. .. ... .._......._............ nor and/or Corataactor}
<br /> (plot plan, showing size of lot, location of system in relation to wells, b inns, etc., can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY
<br /> _...__..._�
<br /> APPLICATION ACCEPTED BY.... ...,;z.. ."...:"p .^ra_.. ....... ... . ...-.. DATE.. :.:...Co � ..
<br /> R VIEW
<br /> E >D BY. - ..._.....-•-......_.'............. ................................._----...._ :_.«.... DATE.................. ._...«....................._._.,»....
<br /> BUILDING PERMIT ISSUED......................................,..... .,_... _.._ ._:.....:.....,... DATE...........w.................................. .....,,,.
<br /> Alterations and/or recommendations:.........._........................................... ...........................................I........
<br /> ..., ..
<br /> ................................. ...................................._........_..............................._ ..._ ....... ...................... .........
<br /> ...............I...”....».................................-........................... ...............................................................................................................................
<br /> /''' r
<br /> FINAL INSPECTION 8Y•.,✓" l� ►� t ...Y,! . , _..._... .__....r...........
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South Americor.Street 300 West Oak street 124 Sysornove Street 30S wear 4t#Street
<br /> Stockton,California Lodi,California Manteca,California Tracy,California
<br /> ES 9 AEVISCO S—S9 2M 5-64 ATLAS
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