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FOR OFFICE USE; ,ZZ <br /> _.__ Q APPLICATION -FOR SANITATION PERMIT -- Permit No. ... <br /> ---------------------------'-- (Complete in Duplicate] <br /> Date Issued --- <br /> ---- <br /> ___ ______________________________ ----------- .-- � This Permit Expires I Year From Date Issued <br /> . . 1 <br /> { Application is herebyemade 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 w b County Ordinance No. 549. 1 <br /> 9 <br /> JOB ADDRESS AND�LOCATION-----------------------L-_----- l', ---- n. -C ----- <br /> Owner's Name----- v(�' y-._,j_....... Phone <br /> �Q <br /> Address------------- ------------------------------------------------------------------------------- <br /> ---- - <br /> Contractor's Name ----------------------- Phone--------------------- <br /> _. -- _. .-• -- - - <br /> Installation will serve: Residence P'Aparfinent House ❑ _Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_____ Number of bedrooms _ Number of baths _A__ Lot size /•t- �73Xjr33�j1_�- ZOg�S <br /> _ system 3 <br /> Water SuPPIY� Publics stem ommunitY Private ❑ De Depth to Water Table . <br /> �-- - I <br /> Character of soil to a depth of 3 feet:• Sand ❑• Gravel ❑*Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No New Construction: Yes E�_Nlo ❑ FHA/VA: Yes,-.2i o 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: * t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ^ y <br /> Septic Tank: Distance from nearest well_____'��____Distance from foundationl0........ <br /> g �No. of compartment- -----------------Size--- depth_._•,--_--------_Capacity---- <br /> Disposal-Field: <br /> --- <br /> Disposal Field: Distance from nearest-well --- <br /> Distance from foundation---LP.............Distance to nearest lot lines ----- ______ <br /> Number of lines_ " _____________ g la__'.Width of trench___.r, _4,._. - <br /> � . f <br /> �� � �-,-�____-- __--Len th sof each l i ne_l_tla___`-ia�_.- '----------------- <br /> Type of filter material � d _ --------Depth of filter material__ 9 ------ -._.-Total length----��-P_-`____________________ <br /> �.. I. /0 r r <br /> Seepage Pit: Distance to nearest well!-7=___--___Distance from foundation____________________Distance to nearest lot line!5__________-._ <br /> 3 <br /> Number of pts------- _'_____Lining materialil. P-4��-------.-Size: Diameter-_--13------------Depth_...__. _X� --------------- ` <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__--------_t.... Lining material <br /> ❑ Size: Diameter--- ------------------------- ----Depth__ -- ----------------------------------------- Capacity-=--------------------------gals. -1 <br /> Privy: Distance from nearest well------------------ ---------- ------------------Distance from nearest building__________________________- <br /> ❑ Distance to nearest lot line-- --- -- ----- ------------------------------------ ------------------ ------------ ---------------------•-------- ( e <br /> Remodelin and/or re airin (describe):f <br /> F <br /> _______________________________________________________________i_FI_____��______-_.___.__________________________________________.____________________�____.__.----_-.____-.--____.----________-____.___-__________.i__ <br /> r- <br /> _______________________________________________________ ______ ___________________________________________ -------------__•----_ _ _ ___________.--_________----____________________________._.___________-.__,_._._ <br /> --- ---- # t <br /> I hereby certify that I,h efiprepared'this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,�-and�--rulend Iregulatians of the San ,loaqui�Local Health District. 4 + <br /> ✓t! <br /> 'u _______________ Owner and/or Contractor) <br /> (SFgned)_____._---------- -f _ _________________ ____ _ _________ ______ _________---._.___._ ____-.___. { / ) <br /> ,° -- - - --- ----------------- ----- Title ---------------------------------------------- <br /> By: s--------------F - - - E ,. ( ) <br /> (Plot plan, showing size of lot locationlof system in elation to wells, buildings, etc., can be placed on reverse side). } ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 4 -- -fir-tom---'-------- DATE - 1 r� ----------- ---- <br /> f rrt ,, # <br /> REVIEWED BY = ---- - ---------------------------------------------- ---x DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------- =--------------------------------------------r----- DATE------------------------------------ ------------------ ---- <br /> Alterations and/or recommendations:_.-. _ _.!-4'�J'6 -L__-._Z _ ------- <br /> ­­ ----------- <br /> ___-__---_--___-____-__ f.-. ia-.___4_ -C.-__ -L-._1 �.e �=Y._.1__ __�/_rr Vii„.____{1':'_^ �.g_'_ __ � <br /> _-.__.____.___________________ _________________________'.__..-_---------__ --------------- _------_-_-__-_..__.________.__-.______.-._______-__________-_-_________.-___-__-____-.-.__ r .- <br /> ________________________________ <br /> -------- ------- ----------------- <br /> --- -----=- - ------------ ------------ - <br /> ------------------------- - ------ -- -- -------------------------------------------- -- ------ ------- ------------------------- <br /> j <br /> FINAL <br /> .INSPECTION BY:. = -�' 2�� Date- � - 4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street a <br /> Stockton,CalFfornla Lodi,California Manteca,California Tracy,California <br /> F.P.CF1. - <br /> k, <br />