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APPLICATION 'SANITATIO-N PERMIT <br /> (Complete in Duplicate} <br /> Date Issued <br /> Applica4ion is hereby made to the San Joaquin Local /- <br /> Health D a permit to cons rust and install the work herein described. <br /> This application is made in compliz;nce with County Ordinance No- 49, <br /> JOB ADDRESS A ?DCA <br /> -- ------- <br /> -Name--- - - - ------------- ------ ------------------- - ---- - --------- - <br /> ---------- - --------r ------------------------- <br /> Phon <br /> Acldress.._<—--------- --------- <br /> Contractor's ----- ----------- <br /> Name----------- — --------------------------- .... <br /> --- ---------- <br /> Phone <br /> Installation will serve: Residence Aparf;;;;�f.H&u-se"..'] Commercial [j—Trailer"C8urt <br /> ❑ ❑ <br /> Number of living ....... VOtel ❑ Other <br /> umber of Uedroo.ms Number of bath <br /> Wafer Supply: I s -/L.of.size -"-- <br /> Water system, C,Community sysfern"[] Private E] Depth to Wafer 'Table ��Pff. <br /> Character of soil to a depth f 3 feet. Sand i F <br /> No��.. Gravel [] Sandy Loam [] Clay Loam 0 Clay AdoborHardpan 0 <br /> Previous Application Made: Yes Ej New Construction: Yes <br /> TYPE OF INSTALLATION AND SPEC t K16ATIONS: <br /> e (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) <br /> Distance from nearest well------------- ---Distance from-foundation_ <br /> No. of compartments--:.--,-.--,---—---------- Size_----- ---Material------_----_.-__-------------------------------- <br /> ol� L -----------------------Liquid depjh--------------------------Capacity------------------------ <br /> 4 <br /> Distance from nearest well------------- Distance fro foundation--------------------Distance to nearest lot line <br /> Number of lines----------------------------- il! ---------------- <br /> Type of filter materia ------Length of each�.Jin-e---------- ------------------"Width of french---------------------------------- <br /> epa p ePfh of filter material---- T.Total length ...... <br /> elI -------/ <br /> - -----Distan f f dation_ <br /> S Pit: Distance to near, - ----- - - - ------- / ------ -------------------- <br /> e%1 -X&__.D -_---e <br /> Number of pits_--'.- -_____----Lining maferia f _t e,�o nearest I line-.1-le ... <br /> �; -Size: Diq"mef�r Depfhf-- ------- <br /> ------ ------ <br /> pool Distance from nearest well-----------------Distance from foundation <br /> Ye : & 1:f5e:17 ;i <br /> ElSize- Diameter--------------------------- -----------Depth--------- -- ------ Lining material-------------------------------------- <br /> Privy, ---------------­------ ------------------Liquid Capacity-------------- <br /> --------------gals. <br /> Distance from nearest well_________________-------------- ---------------Distance from nearest buildin -------- -------------------------------- <br /> Distance to nearest. lot line g -- <br /> ------- ------------- <br /> Remodeling and/or repairing (describe}:---___________________----------------- <br /> --------------------------------------------------------------It F <br /> -•-------•---•---•---------- ---------------------------------------------------- <br /> ----------I----------------------------------------------------------------------------_--------I---------I------ <br /> --------------------------------------------------------------i-----------------­---------I ----------------------------------------- <br /> --------------------------------------------------------------m�-------------------------------------------- <br /> ---------------------------------------------------------1.1------ ---------------------I---------------------------------------I------------- ------------------------------- <br /> .ha repaired this application <br /> I he b erfify that I ha <br /> C, <br /> f San <br /> --- <br /> ordinan f I e J, he work will be done in accordance with 5--a---------------*---------------- <br /> a Lo n Joaquin County <br /> and r es. nd regulations f A ca, <br /> He'lfh District. <br /> Ir Ic <br /> (Signed}-__ <br /> --- --- ---------.... .... --- ---- --- -- --- - ---- ------ I-- -- ------- ----- ------------------------------- (Owner and/or Contractor) <br /> By:------------------------------------- ----- <br /> - ---------- <br /> ---- -------- <br /> (Plot plan, showing size of lot, ca Pori of system in elation to lisp buildings, etc„ can be placed on reverse--side)--------------------------- <br /> FOR DEPAR ENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> REVIEWEDBY --------- ----- ----------------------------------------r------------- DATE---- ---- ------------- ----------------------------- <br /> --------- ---------- - ----- ----------------------------------------- ---------- DATE--- <br /> ---------- <br /> ------------------ --- ---------------------------------------------- <br /> ornmendaflons: - ----------- -------I--- DATE.. <br /> BUILDING PERMIT ISSUED----------------- <br /> Alterations and/or rec' <br /> - (------------------ <br /> --------------6--------------- •........ <br /> ------------- ----------------- e-�_ ------- --- -------- -- ---------------------------- <br /> ---- ---------- ---- ---;--- ----------I--------11--------- <br /> ------------------------------------ - - ---------------------------- <br /> -------- ---------- ------------------------ <br /> ------------ ------------------------------- -------- -------- ---------------- ------------------------------ --------------------------------- ----------- <br /> - ------------*------------------------------ ----------------------------- ---------------------------- -------- --------------- <br /> ---------------------- <br /> -------------------- <br /> --- --- ----- <br /> <� •�i5------------------- ---------- <br /> FI.NAL INSPECTION BY: - <� <br /> Date... .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street '300 West Oak Sfraef 132 Sycamore Street <br /> Stockton, California 814 North "C" Street <br /> I Lodi, California Manteca, California Tracy, California <br /> II5446 ATw000 IZ-54 <br />