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` .FOR OFFICE USE: <br /> ---•-- ----------- <br /> APPLICATION FOR SANITATION PEltM `` Permit No. .Rp-��`r� <br /> (---- --.-___- (Complete in Duplicate) 1 <br /> __..__- This Permit Expires 1 Year From Date Issued Date 4ssued _��j---- <br /> ---- ----------------- t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is made in compliance with County Ordi nce No. 549. <br /> n y� <br /> JOB ADDRESS AND LOCATION- _/ ----- --- ----- ---- <br /> Owner's Name----CA? q f-------�&Q ----------- - ---- ------------------------------------- Phone.? ---- -•_ --- <br /> ------------------------- <br /> Address <br /> Contractor's Nasse `# _..- �t---= �CI_;. Phone = <br /> Installation will serve. Residence [!r-`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth�r <br /> Number of living units: __./___ Number of bedrooms J_.. Number of baths _I_____ Lot size -4_ --.. .�- -- -------------------- <br /> Water Supply: Public system 4_�_Community system ❑ Private ❑ Depth to Water TableWft. " <br /> Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe �rd pan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes El No HA/VA: Yes E] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wi+his 200 feet.) <br /> S rte- Distance from nearest well-----------------Distance from foundation---------------------Material-_-----------------------------------__--------- <br /> oofcom a mi3 S't ------ -------5'sze Liquid depth Capacity I <br /> Dispo al Fiei Distance from.nearest well ij Distance from foundation...[__Q--________.Distance to nearest lot line__, .._-_----fir <br /> Number of lines-----I__ _ -------------- Length of each line_ 0--01__ Wiclfh of trench_Aiz--- --------ZI <br /> T e of filter materi ___Depth of filter material____.__- Total length___ ._._ __-____ _______/9 f_______._ <br /> YP - T ;: <br /> Seepage Pit: Distance to neare t w.elI Ek., Distance fro foundatioii4,,. __.-_-. i r to nearest I t line-_ ____ <br /> �j�j _.. <br /> Number of pits.- l•--------- 9 d ---- i-------'1 <br /> �' �' ___-_.L �a�terial-�----- -- --------Size: Diameter ___-. -------.-_--Depth_.. _ .� <br /> Cesspoo : Distance.frog nearest welly___-_---_-Distance fro foundation-------- ----- ___Lining material_____ ____________________ <br /> Size: Diameer Depth ------- ------ -Liquid Capacity gals. <br /> ❑ { !) tea, <br /> Privy: Distance from nearest well------=--------------------=------- -- --Distance fro ne�est'�building�--:-- --------------------- --------- <br /> r <br /> ❑ - - <br /> Distance to Nearest lot Ime -----•-- -----------�`- ---=-----"•�-----'------------ ----- -------- --- ---------''=------ <br /> r <br /> ----- <br /> Remodelingand or re amn escrlbe _--------------___ _ _ .____ --- ___ <br /> P g i( - - -" 1 <br /> �� - = - a <br /> .r <br /> ----------------------------_1- ------ +J =---------------------------------------------------------x- .-w... - _ .......r�a <br /> 7 .,,,rh...�. `�~ ------,--- a ----- -- <br /> ,= -- --- ----- -- ----.-- <br /> 9: nrs...-wr.- +rwww.�r'.V`►w+�4Fv!desrw+rr.M1rww�w4'nwwwi�+�•-.��rr.•.� <br /> I here`by­tCrtify tkat"`I-li5ve prepared+=is application and that the work will be done in accordance wi+h San Joaquin County <br /> ordinances, Stale ws, and ru and re ulations of the San Joaquin Local Health District. <br /> t , <br /> . , <br /> ,_ Z� - ` iCCon+ actor) <br /> (Signed)-- - --------- �- !/C,----- <br /> BY=--------------•--- =; ---------- -(Title)----------------------- ------- ------- --- .. <br /> (Plot plan, showing size of,lot, location of system in relatio o wells, buildi , etc., can be�placed on reverse side). <br /> `.., t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------04e` ,5 - -------------- --------------------------------- - DATE--------- :?v r ----------------------- <br /> REVIEWEDBY----------------------------------- ---- --- ------------------------------------r----------------------------------------- DATE-------- --------------------- -------------------- ------- <br /> BUILDINGPERMIT ISSUED.------------------------------------ - DAfAf ll-- ---------------------------------- ---t-------------- <br /> Alterations and/or recommendation_______________ _--�. _ .---------- - --��� �= "- ---r- =�" =-`-�``-- -`� <br /> ------------ -- -----------•---------------------------•----------- <br /> - <br /> I. ----- ------ -------- -------------------- ------- - -------I------------------------ -------------- ------------- <br /> --------------- ---------------------------- - -------------------------- ---- ------------------------- --------------------------------------------- -------------------------- ---- -------------------- . . <br /> - <br /> FINAL INSPECTION BY:._.__.. _ Date ... /____....- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.R.co. <br />