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FOR OFFICE USE: �I�L& I63 <br /> APPLICATION FOR SANITATION PERMIT P <br /> -------- <br /> ermi+ No.-- ---------------- <br /> -------r------- --------------------- -----, - (Complete in Duplicate) <br /> //. - __- -3-___-_.--_ This Permit Expires 1 Year From Date. Issued <br /> Date Issued 1 <br /> #xP—PiXon is her y the San Joaquin Local Health District for a permit to construct and install the workherein described. <br /> This::%g�lication is yapafl�in ompliance with County Ordinance No. 49. .� <br /> 7 -- <br /> JOB ADDRESS AN LOCAT ON- `-`---- l.... ' ----- �1 <br /> /j 1t <br /> ' - -... one <br /> Owner ------------- <br /> ---- --- - <br /> Owner's Name----- --' <br /> .s <br /> Address-----_---------------- J <br /> --- Phone.. <br /> Contractors Name---- = -- - , J.. <br /> J , <br /> Installation will serve: Residence Qopartment House ❑ Commercial ❑ Trailer Court r❑ Motel ❑ Other ❑ <br /> Number of living units: Z��7' er of bedroom' -_ Number of baths __ rLotstze - -- --------------- ------ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: 4 Sand E] Gravel E] Sandy Loam El LLoam F] Clay El Adobe Hardpan ❑ <br /> V <br /> Previous Application Made: {If yes,date--.. _-.._,____---J No New Construction: Yes ❑ No Q HA/VA: Yes ❑ Nosy <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest well--------------_-Distance from foundation----------_-----:_.Material_------.-__----.-:--------_---------_______----. <br /> /-5%/i✓ No. of compartments------- f Siie------------------------- Liquid depth Capacity <br /> D,s oral Field: Distance from nearest well----------------dDistance from foundation------------------.Distance to nearest lot line----------------- <br /> �T,pe-of <br /> Number of lines-----------•-- '------:/--Length of each line--------------------------'---Width of trench. ---------- :------------------•--filter material----.-----;----: __-----Depth of filter material-------------------I---Total length-----------------_------------- ----- <br /> / �: <br /> Seepage Distance to nearest well----_.r4�-Distance from foundation----/-_4)__4___.Dii�jJtance to nearest lot line-- <br /> Of <br /> ine-- <br /> N r of.pits____-.-1--.-_-----.Lining material.-� � .-_Size: Diameterf?_f/._-.___Depth > y� f - F <br /> e� .� Q <br /> P ��� 1 , <br /> s ool. Dis ante from nearest well-----=----------bistance from foundstion____----- -_.___.Lining material___....-_---___--_-.----_____-_----- <br /> it ❑ Size: Diameter-------- --------------I-------------Depth------------------------------------------------`---Liquid Capacity- ------------------------gals. <br /> Privy: Distance from nearest well---'---------------------------------------------Distance .from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line_,,-------- ------•---- ------------------------------------------------------------- ----- <br /> Remodeling and/or repairing {de"Cribe}:=--- '- ------ -------------------------------------------------------- <br /> 1 ---------------------- --------------------------------------- <br /> ------------- ''`- = <br /> ------------------------------------------------------ <br /> t----------------------------------------------------------------- -------� <br /> ------------------------------------ ---------- ----------- -- . <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State lar d rules an ...re ulations of the San Joaquin Local Health District. <br /> (Signed) L`' <br /> - --�-- -------------------------- ------------------------- ---------`---------------:{_(Owner and/or Contractor) <br /> B ----------------------------------------(Tltl -- L ' --..... <br /> (Title)Y� a <br /> (Plot plan, showing size_ ,.lot,_ocat;on of,system in.relat;to wells, buildings,-etc., can be placed on Lever{a side). <br /> :i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------s--- r -- --------------------- -------------------- DATE �l�/� -�� <br /> 3 REVIEWED BY---------------------------- - --- -- ------------------------ DATE 1 <br /> BUILDINGPERMIT ISSUED-------------=-------------------------------------------- =—---------------- ----- DATE <br /> Alterations and/or recorrlme da+ions:--- . ------------------------- - ------- ----------------------- -----------------------------------------------------•------------------------------- <br /> >�;1- - ----------- " �--------CA------------------------------------------------------- <br /> .�� ---------- <br /> ---------- <br /> - <br /> _ <br /> + y _ -- __---•---- _ __ -•-_---__-•---- ----_ <br /> --------" v-r ------------ - - - _-.. r-- -� _---------_ ------.------_ -------_-- _ • -- __ <br /> - <br /> { <br /> FINAL INSPECTION BY:-------L --------- Date------./4-77-�=-- ----- - ------ <br /> ,� * ;_SAN JOAQUIN LOCAL HEALTH DISTRICT 'S 7� <br /> 1601 E.Hazelton Ave. '300 West Oak Street �; 124Sycamore'Street 205 West 9th Street <br /> Stockton,California Lodi,California i Manteca,California Tracy,California <br /> REviseo 8.59 31+1 3•'63 i.P.QQ. <br />