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FOR OFFICE USE:
<br /> --• --- ---- -(�_3.-..-- . ..r.�•...-..-_..__ APPLICA ION FOR SANITATION PERMIT Perini+ No. .__ �o
<br /> - (Complete in Duplicate) '
<br /> "' ---•- ------ - - This Permit Ex ices 1 Year From Date Issued Date Issued
<br /> Application is hereby made to the San Joaquin Lolcal Health District for a permit to construct and install the work herein described•
<br /> This application is made in compliance with Count Ordinance No. 549.
<br /> JOB ADDRESS AND LOCATION__.-I _.Z..t'ra-..C�t�t_ItY ;
<br /> ................................ ............................
<br /> Owner's Name,__-A—I&A-r,__......__C.__ _..--------•------ 4
<br /> ,.---•- ------•...................•--•------••-•--•--...-__.. _.._ Phone._�`.7;�t.�._X.!z!d.'.,3
<br /> Address l°•..Y,`7_�_._ •--Q ,Y.•!
<br /> -----------------
<br /> -•..............-
<br /> Contractor's Name------ f �-
<br /> ........... ---,_...... Phone.!`1,d.
<br /> Installation will serve: .Residence [Apartment House ❑ Commercial 0 Trailer Court © Motel ,❑ Other ❑
<br /> Number of living units: _.�-_, Number of belrooms J__-_ Number of baths _�-,_ Lot size -------Q'±�,k!-.___l__ .��--.-..........
<br /> Water Supply: Public-system E] Community system ❑ Private ©""Depth to Water-Table S_/ftw
<br /> r
<br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel EIVndy Loam[) Clay Loam ❑ Clay ❑ Adobe[r] Hardpan ❑
<br /> Previous Application Made: (if yes,date......_ ._,-..I-.-_ J NoNew Construction: Yes �o ❑ FHA/VA.Yes❑ No
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br /> I +
<br /> r
<br /> Septic Tank: Distance from nearest well__.__.p_......Distance from foundation_,. °............Material.pr---a.?-j-�--�o��r�7`�
<br /> 4` No. of compartments:.. _-_�___-___ Size_.y?�_Sx .�.0 ...Liquid depth_.-�_�/_.._. Loc!
<br /> ..._....Capacity._L.? , _ _
<br /> Disposal Field: Distance from nearest well....t?........Distance from foundation____��'
<br /> _______ ______Distance to nearest lot line..s.�,...... 0
<br /> Number of fines...............2_...-k .___7s
<br /> ---------Length of each line___ ................ of trench......2_"__,_- „_•,_____„
<br /> _
<br /> Type of,filter.material_.. e_5_ ._-_Depth of falter material____5K..•_-___--Total length.__•., ✓s0_i •_____,__„_______•• �
<br /> Seepa It: Distance to nearest well____/,''_".v----••_Distance from foundation....Z-! .........Distance to nearest lot line.S ........... 0
<br /> Number of pits:........ _..__-____Lining material____ ��_h-_-._.Size: Diameter__-_3.3-.............Depth___ .2 '
<br /> l
<br /> Cesspool: Distance from nearest well......_.,.........Distance from foundation-----...............Lining material_______________________-------------- ,t
<br /> ❑ Size: Diameter.__... I_,_------Depth---• --•--------•-•----_---------•-------------Liquid Capacity gals.
<br /> ;-
<br /> Privy:' Distance from nearest well.----------------________-______.___.._...._..Distance from nearest building
<br /> g ,__,,,
<br /> ❑ Distance to nearest lot line-------
<br /> Remodeling and/or repairing (describe,:..........
<br /> -------•...............•-•-•--...-----,__,__••----------•------- N
<br /> ----••------------•----------•-•-------- •--------------------_...._.------•--•-•-•-..._._..__._._.-•---
<br /> 3 ..-
<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 Iand rules and regulations oV the San Joaquin Local Health District.
<br /> a
<br /> (Signed) - •-------'----- .--•-------•---•------- ------------------------------ --•-------_._---(Owner and/or Contractor)
<br /> By:__..._..... ........ -•---••---•••--•-••-------- --------- ----------------------- -- •------------(Title)--... -
<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 ��.LL
<br /> APPLICATION ACCEPTED BY---...-- .•-------------••----•. - --------- ------- - - -- `V'DATE 1_�......._!_._�.G'
<br /> REVIEWED BY _... __.-,----------- ---_---• DATE.................•---•--.
<br /> BUILDING PERMIT ISSUED---------------------------------------- --------------_
<br /> � ---• . ... .
<br /> :�-•- Q . .......;.Alterations and/or recommendations:._.-/,/.—J. - y -:.
<br /> .............. ........................ ....•---------•--............_-...... ----..,_...---.----
<br /> f
<br /> FINAL INSPECTION BY:..... �1......... ..........--••-• Date.............!_/_-r/..
<br /> .................
<br /> ��. ..
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1601 E.Haselton Ave, 300 West Oak'stroet 1 ` 124 Sycamore Street 205 West 9th Street
<br /> Stockton,California Lodi,Callforn is Manteca,California Tracy,California
<br /> E9 9 REVI9E0 0•e9 3M 3-'63 F.P.k:9. �
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