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APPLICATION .FOR SANITATIONPIERN! ~ ermrt <br /> +•e. �. ,.,. ,` (Complete in-Dupill"4) �� y <br /> Date Issued ..... <br /> p icati. is hereby made to.the.San Joaquin Local H •str(ct,for-a permit to construct and.install the.work'horein described. <br /> is application is made in compliance with County Ordinan eolfih No. 544 <br /> r <br /> `4 JOB ADDRESS AND OCATIOM...- ! ------ - <br /> ...............................:.. <br /> / <br /> Owner's'Name__. .. Phone_- ! <br /> Address.----•__.-- -�- - •----.... .... :.__ -..�L...�� <br /> -_ <br /> Contractor's Name----------- .._..,• ---•...................................................... - Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motet [] Other ❑ <br /> Number of living units: .. Number Of bedrooms sZ Number of baths __1.__:Lot size •-...... <br /> .. <br /> Water Supply: Public system 171Commuety system ❑ Private Depth to VI/eter Table.. ft. <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ SandyLoa ' Clay:loam❑ Clay❑ Adob@ Hardman <br /> Previous Application Made: Yes ❑ No� ttwCopstruction: Yes ❑ N t ; r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public;ewer is available within 200 feet.) <br /> Septic Tank: Distance.from nearest well. Q .D Isfance�from'fgun atipn._y� .-••. .Maier, , `!e4, <br /> '�` `� r X: <br /> No. of compartments_._.___________ Size__ .,, �yrLiquid,depth f�.._ ..,. Capauty <br /> Disposal Field: Distance from nearest well.________________Distance from foundation_._ ._...........Distance to nen igtiine 5;� <br /> ❑ Number--V lines...................................Length of each line.....-•-_-_•-.......................Width of trench <br /> Type of Pilfer material________________�_./_ Depth of fit terial..........., ._Total length, .. _.. .: <br /> Seepage Pit Distance to nearest well___ .JJ _:..Y3i a on1 f ion _:._..Distanc@ to nee lot Itn <br /> Number of pits_..._ ._ Lining m tial e: iameter __.. Depth.. . <br /> Cesspool: Distance from nerirest v�ell istnnce f radion ,Lining material . <br /> Size:-'Diameter---_.. .:•---t De f 'aor•• ............. --_._Liquid Capacity` r <br /> ,rivy: Distance from.nearest well................................ _._.... D13tance from nearest building_ w <br /> (� + tante to nearest lot fine ,...-•-••...... - -....._,... , <br /> Remodeling and pairing (describe) ----•- ••-•------ .. <br /> .................... ........ -_......................._....---•-•-•••-.._..... - - - <br /> _...__._._. ...... ------ •----------•.--_-- ._ _. <br /> I hereby'certify; at Fhve•prepared this applicatiop and that the work will be dona.in'accordance w' +en;Joaquin <br /> ordinances, Ste ws, and I nd regulations of the San Joaquin Local Health Distrio. ' <br /> { __ ---•--(Own@r grid/or fi <br /> (Signed) --- -----:: -------------------------------------------------------------••. <br /> A. <br /> -f _ .._. .. .... ... --...1'--_...... •-•--••---...................................... F�! -•- ......... <br /> --. M <br /> (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., placed on reverse side(. <br /> FOR DEPART T USE ONLY <br /> APPLICATION ACCEPTED <br /> BY --------- - - DATE, <br /> REVIEWED BY , <br /> ---•--•------ --• -- ---- -- ----------------------•- ---------'------•---------------- DATE_--- •.�+`"''-�. ". <br /> BUILDING PERMIf:ISSUED--_ <br /> • DATE_._- ...µ <br /> Alterations and/or'recommendations:-------------------------------------- •--.•_•••--...-.----•--- ._ <br /> -------------•----•-........ ..........................------------- - _ . <br /> _-......••................ ..... .•___.....__ ...yx <br /> k ... ----- -------------- . •----- ---- --- -------------- 4� <br /> FAL, INSPECTION Date .............- ' ------ <br /> a: <br /> � .. •-•-•-... • ---•- -• <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street. 300 West Oak-Street 132 Sycamore Street _ ;_.8F4 IVdrth "C"SisNt <br /> Stockton, California Lodi, California` Manteca, California Tracy, dalifornia <br /> ES�S-4-2M 8-51 Revised W-2100 , <br />