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Permit,N <br /> 45" 4;;�,��PPLICATION� FOR. SANITATION PERMITy P O. <br /> (Complete in Duplicate) <br /> Date Issued -------7-/./ <br /> A it to construct and install the work herein described. <br /> This <br /> is hereby made to the San Joaquin Local Health District for a perm <br /> is application is made in compliance-withI County Orclin/ance)No., 49. <br /> A , / 4 --- <br /> TION --- ---- -- ----------- --------------------- <br /> -t-L --------------------------------------------- Phone,�,_ <br /> JOB ADDRESS AND <br /> ------ ---- <br /> Owner's Nam -------- --- _jP <br /> Address- ------- -----------------------------------------------------------------I------------------------------------------------------- <br /> or 1-do ----------- <br /> Contract s Name------------------ --------------- ------------------------------------------------------------------------ Phone. - <br /> "---- - <br /> Installation will serve- Residence F-I. Apartment House [I Commercial E] Trailer Court 0 MofelO Other F1 <br /> Number of living units.- )-l"'N6mber of bedroomsl-7--- Number of baths Lot size,._�✓---- ------------ <br /> Wafer Supply: Public system Community system El Private E] Depth to Wafer Table ft. <br /> I <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam E] Clay E] Adobe Hardpan L) <br /> N <br /> Previous-Application Made: Yes E] N XO New Construction: Yes El 0*/ 11 <br /> 1j\ <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----77777776-isfance from foundation--------------------Material------------------------------------------------ <br /> No.,o-rf compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity------------------------ <br /> Diesptosa?[?Fiiel Distance from nearest well________----------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> F2 Number of {fines-----------------------------------Length of each line---------- Wicifln-of trench----------------------------------- <br /> L Type <br /> rench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------------------)---- <br /> Seepage Pit: Distance to nearest well_____-"_"""_________Distance frono fpunclation--- --------------Distancq to nearest lo line____________ <br /> 0 Number of pifs-_I____1-------------Lining material <br /> --fr ___________.Size: <br /> _ -------Size: Diameter-------#:o4�_.Depfh-- --d-**-___---"-__---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundafion------ -------1ining material-------------------------------------- <br /> Size: Diameter------------------- ------------------Depth------------------ --------------- -----------------Liquid Capacity----------------------------gals.i <br /> t ------Distance from nearest building--- -------------- <br /> -Privy: Distance from nearest well------------------------------------------- -------- ---------------- <br /> ElDistance to nearest lot.line------"--------------- ------ ------------------------------------------------- ----------- ------------------------------------ <br /> Remodeling and/or repairing (clescrib ----- ----- ---------- le-941-7 --- --- --- ----------- <br /> 7 -------------- --------- <br /> 7----- - - -- ------------- ----------- --- --------- - -------- ---- <br /> -------- ---------------------- ---- ------ -- <br /> ------- -------------- --------- --------- - I------ <br /> ---------------------------------------------11-------------- ------------ - ------------------------------------------------------------- ___­-------------------j---------------------- <br /> -------------------------------------------------------------------------1-1------------------------------- <br /> I hereby ce®rtiff that I have prepared this applicaf d h he work will be done in accordance with San Joaquin County <br /> that <br /> "on a" <br /> Sta I he San Ja Vin Local Health District. <br /> ordinances, laws, an luldl ai4d regulations of fl <br /> caner dZo ntracfbr) <br /> n r a2n L.0 o o <br /> (Signed).---------- --- — ------- -- ---------------I'--- ---- ------------------- -:7— �� I <br /> 0 -- ------ -------- <br /> By:------------------;17� ..... - ----- -------- --- -- ----- ----- - -- - <br /> -------------------------------_(Title]__ 4. <br /> i rel tion to wells, buildings, etc., can be placed on reverse side]-00e <br /> (Plot plan, showing e ze o lot, to on em in <br /> FOR DEPARTMENT USE ONLY <br /> ACCEPTED BY-(—-------------------------- ---------- J— -----------------------------------------------: <br /> APPLICATION ACC ------------------------- ----------------------------- DATE <br /> ................... ----------------------------------------------------------- -------------- DATE____- ----------------------------------------------- <br /> REVIEWED BY_------------ <br /> BUILDINGPERMIT ISSUED-------------- ---------------------------------------- --------------------------------- DATE----------- -------------------------------------------= <br /> Alterations and/or recommendations:-------------------------- -- ---------------------------------------------------- -----------------------------------------=--------=--- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------•-------------------------- -------------- <br /> ------------------- - <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- <br /> ------------------------------------------------------ ----------------- ---------------------------------------------------------------------------------------------------------------------- ------------- <br /> ------------------------------------------- ----------------------------------------------- ----------- <br /> ------------------------------------------------------------------------------------- <br /> ------------------------------ -------- <br /> FINAL INSPECTION BY:- Date-------- <br /> V4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 814 Nord ..C.. S!i) <br /> -Stockton, California Lodi, California Manteca, California Tracy, Califon <br /> E5-9-2m 85.1 .Revised W-2100 <br />