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FOR OFFICE USE: <br /> �af <br /> ------------�1-3 a--- '' ` � F <br /> S ��`= a APPLICATION FOR SANLTATION PERMIT Permit No. .�____________________ <br /> ------------- ------d''•-1A..... (Complete in Duplicatel Date Issued ___7,� ,7 <br /> _-------------- :f This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local`Health District for a permit to construct and install the work herein described. <br /> This application is made in complian with County Ordinance No. 549. l <br /> ---------------------- _ <br /> JOB ADDRESS AND L CATIO '``""" <br /> Owner's Name------------ � :�— <br /> Phone__.' - <br /> i <br /> Address 61 I x.-_ v __ _._ -------- -------------------------- .- - ------_-----------------•-•------- <br /> Ct ' �� ------•-------- s Phone <br /> -- <br /> Contractor's Name <br /> U` �c =.-- _ <br /> Installation will server Residence E] Apartment House E] Commercial railer Court E] Motel E] Other ❑ <br /> -------- -- <br /> Number of living units: _____--Number of bedrooms __ _:.Number of-baths ________ Lot size ----------------------------- <br /> r 1 <br /> Water Supply: ,Public system ❑ Community system E] -Private [rfSpth to Water Table ____--._ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam E] Clay � Adobe D—Hardpan ❑ N d <br /> E Previous Application Made ``(If._yes,date.r- <br /> No_�New Construction:Yes o ❑j FHA/VA: Yes E] No E].. <br /> TYPE OF INSTALLATIOWAND SPECIFICATIONS: <br /> (No.septic,,tank or cesspool permitted if publia-sewer is available within 200 feet.) <br /> Septic T nk:. r- Distance from nearest wellA2Av_ ?1?_Distance afro mfpunclation_mAtt-_1.0.FMaterial__.(,fp.<,��s"� -___________________';` <br /> No. of. 2b Se_---.---Liquid depth_.:_'-- Pacity_.. <br /> Disposal ield: Distance from nearest well.C1A,1,�_-'-Distancefrom fcundaticn__¢'1t' _�O----Distance to nearest lot <br /> �[ ,' Number-of lines 1---------XV_---;-----------Length.of each Iine�y�11,�,P_/-----------.Width of trench.......... - --------------- 0� <br /> Type of filter material_ 1 _ r---Depth of filter material_--_„��_-.__.___.Total length___-_____ 51!?____________________ <br />' Seep"a e,Pit:"' Distance to nearest well.r?i 'lC7ti`_ Distariee,from foundation_�±2�Nf ___.Distance to nearest lot line_. r <br /> r <br /> Number of pits------y------------Lining materialQ .______ _'.size: Diame+e ".. -------Dept k <br /> 01� 6—j <br /> Cesspool: Distance from nearest well-----------------Distance from fouridation-----------.------..Li€ning material__----------------------------------- 70t, .� <br /> Size: Diameter__-_�---------------- -De <br /> ----= ----- p <br /> th-3 `_ - <br /> ----------- ------------ .------------ ----Liquid Capacity----------------------------gals. <br /> ❑ .. - , <br /> Privy: Distance from nearest well----- -•-:--------------------t-------------------Distance+(5m nearest buMing------------------------------- <br /> t <br /> -- - <br /> ❑ Distance to nearest lot line ' <br /> _+_r r _ <br /> ---------------------------------------- <br /> t� -� <br /> Remodeling and/or repairing (describe):--------------- ----------------- -----'------------------------------------------------------------------------------------------------ ------ - <br /> ------------------------------------------------------------------------ <br /> ----- -------------------------------------- <br /> ----------------------------- ------- ---`----------------------- <br /> — F _r. <br /> I -. . - ; ------- <br /> ------------------------------------------- <br /> 1 hereby ce ' that I have epare this applications 'and',that the work will be done in accordance with San Joaquin County , <br /> ordinances, a laws, and r s and'regu tions ofr the'San Joaquin Local Health District. �►' <br /> T <br /> i --------(Owner and/or Contractor) <br /> (Signe ---- -------------5�:k----- -------- ------ ------------------ <br /> By:----------------------------------- y -' ------- --------(Title)------------------------- -- ---- ----..._: <br /> (Plot plan, showing size of lot, location of S stem,in relation to wells, buildings, etc.; can be placed on reverse side). <br /> t <br /> 'FOR DEPARTMENT USE ONLY <br /> a <br /> --------------- <br /> APPLICATlO"N ACCEPYED'8Y-` - - -- - - %� .. -. Afi;E'_"'._--{ f <br /> D - <br /> ti C.' '-- DATE -- ------------=------ ------:- � <br /> REVIEWEDBY------------ ----------------- --------------------------------------------'-- - ---------------------------------- <br /> --------- DATE-----------------------------------------�t---=-- <br /> BUILDING PERMIT ISSUED.................. ---- ----------- ---`------ ----=�-------5 _. _ _ __ ----------------- r -�-r, <br /> Alterations an or recommendations:_____ <br /> / 1 . .� <br /> ----------------- <br /> ---------- Z� --- <br /> - <br /> -r ....cJlGt9 -}.S,er,�_�urL•� '-- 'a-G[" - P <br /> FINAL INSPECTION BY:..-.__.._- <br /> . ��i�- Datef <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />