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FOR OFFICEUSE: <br /> 5 <br /> --------------------------------- <br /> I <br /> ---------------- , .r,. C <br /> --- - <br /> 1` s` PPLICATION', FOR'FSANITATION PERMIT Permit No. <br /> -- --- - G 3-_ <br /> ------- -------- -- ---- - (Complete in Duplicate) i C- J., <br /> ---------------- This Permit Expires 1 Year from Date Issued Date Issued <br /> Application is hereby made to the San JoaquiniLocal-Healfh-District fore peri .o construct and install the work herein Ys ribed. <br /> This application is made.in,co ' nce with County Ordinance No. 549. + ,O' I <br /> x(7303 0, /1D _ -- <br /> JOB ADDRESS AND LOCA --- —:�i - !H S E T= 1�� ' `' 1 F - ` / l"�----- <br /> VC <br /> # j <br /> Owner's Name--------------- - L+1 =--------------------------------------------------- Phone------------------------------------ <br /> Address......... � -•`-- =��c��k----- ------------I ©n-------------------------- +- -_=_ <br /> Name_____._Q1�!_. t --- ........... <br /> -- --- - ------ ------------- �--" ------------------ --_... Phone---------------------------------- <br /> Contractors. __ . _ '_"' <br /> Installation will serve: Residence )]Apartment House ❑ Commercial Trailer <br /> Court ❑ Motel Other <br /> Numbe of living ng units: -1--__ Nr of bedrooms Number t L4 04ot size ❑° <br /> __ a _______r 1 . <br /> Water Supply: Public system ❑ Community system ❑ Private ®—Depfh to Water Table <br /> Character of soil to a depth of 3 feef-I Sand - Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 'J <br /> , <br /> Previous Application Made: (If yes,date--------------- NoRI�New Construction: Yes N o © FHA/VA: Yes ❑ No a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> — ~(No-septic tank:or cess600l perry i r d if public sewer is available within-200 feet.) <br /> Septic Tank: Distance from nearesf"well----�:7?q-----Distance from foundation_______________A-_.Material-- i J1 I- —------------ <br /> FF t%l6__ No. of compartments--------------------------Size-�_-KIZ-x_-5_--___Liquid depth_ _-'� ----_-Capacify_-Z -P--- <br /> Disposal Fiel : Distance from nearest well...,SC`s-----Distance from foundation__-/�-_______-Distance to nearest lot line_ � <br /> �S -i Number of lines_________ __ ��___-_-____ <br /> � -� __ _______________Length of each line____���_..?�_�_-.Width of trench.____.-�. <br /> �Db Type of filter material___ C ____-Depth of filter material___--- -. --___Tota! length--------- --=�f______________________ <br /> Seepage Pit: Distance to nearest well____________ ________Distance from foundation_________________.Distance to nearest lot line....... <br /> p Number of its----------------------Linin materia!-_--- y� ----Size: Diameter-----------------------Depth------------------_---------__.__ � <br /> ❑ p 9 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-__-----.-_-- ----Linin material-------------------------------------- , <br /> Size: Diameter---------------------- --- Depth Liquid Capacity gals. <br /> ❑ � p q p Y-, - --- - - -----g <br /> Privy: Distance from nearest well-------------------------------------- '___Distance from nearest building-__-_--__-_______________________--___--_. <br /> ❑ Distance to nearest lot line ------------ ---------------------- ------------------------------------------ <br /> . r. r*w <br /> Remodeiing and/or repairing (descrnbe�:------ -------------- ---------------- -- ------------------- --------------------------------------------------------------------- <br /> tli} <br /> ---------------­------------•------------------------------------------------------u�R0r---G-0-I --__-_AE;--- 015! `Tf►fs 1�EAc#! .brnl�-----�----------------------------------- <br /> ---------- ------ )-----------------------------------------------------------------•-------------- -• �- <br /> .r <br /> 1 hereby certify that l have prepared this application and that the—work will be done in accordance with San Joaquin County <br /> ordinances, Sfafel laws, and rules and regulatio - of the San Joaquin Local Health District. <br /> (Signed) rf- frf _��--------------------------------------------------=---------------(Owner and/or Contractor) <br /> B t ----- Title ------------------- ------------'�--� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIION ACCEPTED BY------- �Yl�___ ____ _______ _ <br /> -- ------------------------------ -- ---- -------- ------- ------- DATE--------- ----- -��`�----- ----- 4 - - -- <br /> REVILWEDBY---1-------------------- ----------- ----------------------------------------------------------------------------------------- DATE-------------------- -------------------------------------- j <br /> BUILDI°NOPERM�T ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------ <br /> Alterafions and/oi recommendations:----____-- ----- -- <br /> ----------------- <br /> - <br /> ----------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------- ---------------- <br /> ----- <br /> FINAL INS -- ------ Date-------- #7 '., U �--------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamare Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy, California <br /> F.P.C C. <br /> 1 � I <br />