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FOR OFFICE USE: <br /> = --------,��P <br /> APPLICATION FOR SANIYAYION PERMIT Permit No. a�ZZz_�__-- <br /> �vaG-------_-_-------16 ... . <br /> .. .................................., .Sa. -.-• - (Complete in Duplicate) /nn a <br /> Date Issued .__f�/_.r�/..._....� <br /> ....................................... ... ... This Permit Expires 1 Year From Date Issued <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 o. 5_4 9. <br /> JOB ADDRESS AND L CATION---------�._��----••...... •-----............ .......................... ............................ <br /> Owner's Name. , ...... •------•---••------------ - • ----- -- ------.._....... Phone... <br /> .-•--• . ,= C7 <br /> Address.`r�......----- /-. --•-••............... <br /> ...................................._..---•--••-- <br /> Contractor's Name........ .....CIrLzr� _ ..... <br /> /�~GI! -_...11;. .................. <br /> Installation will serve: Residence 0C Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> t <br /> Number of living units: Number of bedrooms .a._ Number of baths _Z.. Lot size ..._ ................ <br /> Water Supply: Public system ❑ Community system ❑ Private;' Depth to Water Table 641/ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan❑ <br /> Previous Application Made: ;1f yes,date.....................) No)K New Construction: Yes, No ❑ FHA/VA: Yes ❑ No W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well...-S-Q.... Distan f om f undation__f�..__.-..__.Maier:al........ .......................... . ........ <br /> (K No. of compartments .........Size_ -- r Ca aci <br /> p ta�-.:.. >� !� _.:Liquid depth ,L ....---... p ty..A2019.k' <br /> Disposal field: Distance from nearest well-..r ......Distance from foundation_._1A. ... to nearest lot line...._..i.... <br /> De Number of lines----- <br /> .=7--- <br /> _.-_ �_---_--`- Length of each line...10._'___ --------- Width of trench....�________________ <br /> Type of filter material._ Q'C ........Depth of filter material__� _��_.._...Total length.../.,..d......................... <br /> Seepage Pit: Distance to nearest well.Aay. ....__Distance f om f unoation../d_l...__..pistance to nearest lot line.-t ......... <br /> orNumber of pits....ta�.............Lining material-- __.Size: Diameter___-Z2_.'.'..__.Depth....... ........... <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material....---------........................ <br /> ❑ Size: Diameter._.. ...... .........................Depth......................... .............._.Liquid Capacity.._...........-,,..... ....gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building------.._______.______---/... <br /> ❑ s Distance to nearest lot line------_----_•--••--•----------- ----- ..............................................................................V.............. <br /> Remodeling and/or repairing (describe):----................ T <br /> -•----•........................................••--•-•••-•-......................................................................................................... ...................................................... <br /> ------•---------------------------------------------------------------............................--------------•-----..................1.................................................-_..__..--------------_---- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..............................................................................__..... ..............-......_. .__ ......(Owner and/or Contractor) <br /> BY:.........e_. 4.4.44L.." <br /> . .4 .._.._ . . ... . .. .(Title)-----¢' ''"'` ...........................•--- <br /> (Plot plan, showing size o ot, locationsystem In relation to wells, bins, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ^ACCEPTED BY........ - RC----------•-----•-----------------------•- --•---------------------- DATE----------- °��-(��. ............... <br /> REVIEWED BY----..-•---•-•-•---•----------------------- --------------------...._.---*---- -------------- <br /> --- <br /> -- <br /> -- --- ..... DATE--•----•-••-•--............................................ <br /> BUILDINGPERMIT ISSUED-------------•--•-------•---------------------------.._...._....._..................--• --•-- ----.._.. DATE.................................... •... •---........•--.----•- <br /> cera ons a or recommendations:__._.............. <br /> /D... �1�._..., .._. .............. .......... ,�................... <br /> ..... ...... ..... _,. .tr. . <br /> / �i��'�- � - '�� o..�.G�:.G��`�U"t�'`"'°�ic-�.-l"r.e"./.t.�.if•�4`d�'e��'`�.��iU�'� <br /> IAL INSP B ..............�' ........................................ Date--- �C. _.-a2.r�l. --------- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />