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t IV <br /> FOR OFFICE USE: <br /> APPLICATION..FGR--SANITATIONPERMI w <br /> /�; _.-__.--- [CoPermit No. <br /> mplete,in.Duplica+el <br /> ---- --------- Date Issued __��<_ / . �'�J <br /> This Permit Expires Year-From Date Issued <br /> Application is hereby made fo the San Joaquin Local Health Districfi�for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549.x, ' <br /> r �' --------------- <br /> JOB ADDRESS AND OCATION. (JII;P f7! - <br /> Phone <br /> OwnersHama-:---- ----- I _ - -----------------•---•-------------- -------------- ------------- - --------- ---- -- - . <br /> 4- �- ' <br /> ----------------------•-------------------------•-----•--•--•-------------------•---- <br /> Address. '------------ <br /> Contractor'sA ame------- - ---"--`------------------------------- <br /> t <br /> •----------•------ -" _ ti <br /> ---------------- Phone.--------------------------........ <br /> r t ❑, Commercial `Trailer Cour+ ❑ Motel Q Other <br /> Installation will serve: *Residence `Apartment House ❑ ,o t I <br /> g ` _ s 4 Lot size G[/ � X es�.J--- <br /> Number.of livin units: __..___Number of bedrooms __ .___ Number of bath .� <br /> I� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. "`'� _ <br /> Sand Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobea pan ❑ <br /> Character of soil to a depth of 3 feet: S ❑ ❑ - , <br /> I w 4 El <br /> licafion"Made: (If yes,date- ----- -- ----- ----1 No New Construction: Yes [ to E] FHA/VA: Yes No <br /> Previous App <br /> TYPE!OF INSTALLATION AND SPECIFICATIONS: _- <br /> (No septic tank or cesspool permitted if public sewer is av_aiLa6,la,vthin 2_0_0 tqr <br /> -• sante from • �.. <br /> "'ince from nearest we l__4 If____ foundation___ --------Mate L__ :�� -----------"----- <br />'�. Septic Tii< '"" Disro F <br /> ' � �r Li uid de th-----I Caity <br /> ��lo. of=:�mPartments---- - -=== --r= = e ------ -- - - G P. � ---- - - <br /> _, i <br /> :: i r <br /> Disposal Field: Distance from' F�al=�� :'1ei:-_ /�__--__-.Distance to In <br /> lot line__ <br /> ' 9 .from foundation._ .__ ___ � -_-••-------- 1.f1 <br /> umbar of lines------:�' . ." Length of-each line z --- moi Width of trench__/�_�._.__------------------------ <br /> /T <br /> ------------------- <br /> 'f{Type of filter material- / _ _���Depth!of.filter material____/i�_______----"Total .length___eo ?---- -------------1 -__ <br /> U i / r --•- <br /> Seepaige Pit: Distance to nearest well-_X��-----Distance Tr m foundation---IX--_--___ is nce to nearest lot line <br /> l De th_ y <br /> Number of its -=__ L4f�if}g-matsrial -. - -- ---Sizi: Diameter-- --------- P " <br /> E Cess�ooli Distance :fr7m nearest well------------------Distance from foundation--------------------Lining material_.------------------------3.-__-_-----. <br /> IDiameter-7 -------- <br /> Distance <br /> .rLiqud Capacity gals. <br /> Y <br /> Distance from nlearestibuiidi� . -____- <br /> Priv Distance from nearest_well------=--------------------•---- ------------- 9 -------- <br /> Privyl <br /> bistance to{nearest lot line-------- I---------------------- ------------------- -------� -------- <br /> ---------------------------- <br /> Remodeling <br /> ----- <br /> �/� f <br /> e ` __________________________________ �_ ____—_----_-------_-_ <br /> s <br /> Rsmodelin and/or re airin describe-___-:__ *`"�" <br /> ---------I ] <br /> ----- ------ <br /> ------------------ <br /> --------------- <br /> !:� <br /> ----------t--------------------------- <br /> l .. <br /> -------------- __----- e [ - ------------------------------------------------------�;j- _-------- ---------- <br /> I1 hereby certify the# I have prepared;this application.and the# the work will be done in accordance with San'.Joaquin.County <br /> ordinances, State laws l and rules and regul�tior�s,of the San Joaquin Local Health District, w 4 r,..�' .IV <br /> iJ �" Contractor] <br /> Si ned <br /> f[ 9 -- <br /> B - 4 --- I ----------------------------------- ------- -------------- <br /> - <br /> --- - t <br /> [Title) � " ' <br /> [Plat plan, showing size of lot.,locate. f sys+em m relatio to.wells, lauildings, efc., can be placed on reverse <br /> t <br /> z may= + FOR.Dt XRTMENT USE ONLY C <br /> APPLICATION ACCEPTE _BY------------- -- --- DATE_ - <br /> l• rti -----w -- - -' - .... <br /> } ---- DATE----------------------------------------------------------- <br /> REVIEWED BY---=-=-=-�---------------- -- -- --,---� -:--_--:---- --q�----------------- ------------*--- -- 5 <br /> BUILDING PERMIT`ISSUED ------- - --------------------------- <br /> t _ DATE = --- <br /> - ----- -- ------ <br /> /�- <br /> l Alterations and/or recommendations r «------- <br /> - ,��`� -� -------------------------------- ._. <br /> I ------ ---------------------- ------------------------------------------------------ - ------ <br /> -------------------------------------------------------------- <br /> ---------------- --------------------------------- ------------------------------­­------------------ -- -------- <br /> -------------- -�---- -- - - <br /> "- a <br /> F FINAL iNSPECTION BY:---------_______ - --------- _ - <br /> °- Date------------1 <br /> " .� SAN JOAQUIN LOCAL HEALTH DISTRICT 'S <br /> ]601 E.Hazelton Ave. 300 West Oak Street 124 5ycamore Stree}is 205 West 9th Street <br /> 01 E. <br /> California Lodi,California Manteca,California a Tracy,California <br /> StoEs 9 REVISED 8-59 3M 3-'63 F.P.CC. s <br />