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�A Ll <br /> APPLICATION FOR SANITATION PERMI Permit No- -- ---- _----------- <br /> .1 4 <br /> Date Issued ------ . <br /> (complete in Duplicate) , V .... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> r. <br /> JOB ADDRESS AND LOCATION ... <br /> --------- - ------ <br /> ........... <br /> Owner's Name----------••------------ --- --- ---- JAE---------/---------------------- Phone---------­­----------------------- <br /> Address-----------------*---------------- ----- ----- ------------- <br /> ----------------- <br /> ----- ------------- <br /> Contractor's Name---------- ----- ----- <br /> Installation will serve: Residence Apartment House Ej Commercial E] Trailer Court E] Motel Ej Other El <br /> Number of living units: Number of bedrooms A.- Number of ba Lot size --- 47a X----7---- <br /> - Public system E] Community system E] Private. <br /> Water Supply. D'Pth to Water Table-I- _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑I vel 0 Sandy Loam ❑ LE] Clay Clay E] Adobe IIIIIVardp�an ❑ <br /> Previous Application Made: Yes F] N 0 Rr New Construction: Yes [ff- No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se i Distance from n, <br /> i n nearest welIL:!2- 6! Di f founclation-1-JIIII"------Maferi'pl <br /> LqL1aQ0 from - - ''---_---_•------------ <br /> No. of compartments____ 7 ------Size----Z <br /> � 1:111i1`:`[' <br /> Di osal F' Distance from nearer well-- _4�-----Distance frbirn foundation--- -- ------Distance to chest lot Ii <br /> Number of lines.____ ength of each line------- --- -Width of french- -Z <br /> Type of filter material__ 5_._��D'epth of filter maferia--- -- ------------Total length_________ 7' <br /> �.I-------------------- <br /> Ic <br /> Seepavp�)iLf: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_-__.____________ <br /> Cesspool: 7 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth---------------------------- <br /> Distance from nearest well-----------------Distance from foundation___.__________- Lining material--------------------------------------- <br /> El Size: Diameter---------------------------------------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 crib ------------ -------- <br /> L--- ------ .. ...... I............. <br /> -------------- - --- <br /> --- - --- -- - - - - --- -------- ------ --- ----- ------------ -----------•------- -------- <br /> ---------------------­- ----- ---- ------X­--- I <br /> --------- ---- ------- -- ---- ----------- <br /> ----------- --------I---------------- --------- ----------I­-----­ --- - <br /> --- ------------- ---------------------­-- ------------------------ - ------r <br /> --------------I---------- <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 Sfafe I is, c <br /> j _a7d rules a d regulations of the vSanJjaquin Local HealthPistrict. <br /> . . ....... <br /> (Signed)---------- -- -- ------ ----- --- ---- -11 k4_1--119 W_ _--0 -----(Owner and/or Contractor) <br /> By---------------- --a----- -------------------------------------------------------------(Title---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--- ----- ---------------------------- ----- ------------------------------------------------- DATE__��-------------------------------------------------- <br /> REVIEWEDBY---- --"--------------- ----------------------------------------------- DATE____S�—----------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ - ------------------------ ---------------------- <br /> Alterations and/or recommendations:---------------------------- - ---------------------------------------It, <br /> ----- ------------------- --- ------tl-------- -------------- --#--------I -------------- ------------------------ -- -------------------- <br /> xt, 4JAA� t.. <br /> ("I_'Ot ". 44.4 <br /> �tE VI-------------- -------- -------- -------- ------------------------------------------ <br /> ---- - - --- -- -- ------- - /yam <br /> --------------- <br /> ---------- ------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:_____--"""------------------ --- Date- l -/- <br /> o .r-x-------------------- <br /> -- ------ --- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT qcbw <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--9-2M 8-51 Revised W-2100 <br />