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t 5 <br /> ! APPLICATION FC, ,,SANITATION PERMIT.t Permit No. _- <br /> ' (Complete in Duplicate) <br /> Date Issued, � <br /> 1 � S <br /> Application is hereby made to the San'-Joaquin'Local Health 'District for a permit tonstru t nd install the work herein described. <br /> This application is made in complianceswith County Ordinance No. 549. ..� <br /> JOB 'ADDRESS AND. LOCATION--= 1'�-------- <br /> x p <br /> Owne s-Name-..__ .- 9 ( �r� <br /> I - e --------- <br /> As <br /> ------ <br /> Contractor's Name <br /> ------------•---- o e <br /> Installation will serve: ; Residence J�j 1Apartment House f] Commercial'L❑ Trailer: Court ❑ Motel E]. Other ❑_ <br /> Dumber of living units: ---/--- ., ,baths _f_- Lot size ____-7-7X-1? S----: --_z- - � I <br /> kk pp Y y Number ofbYdroomO_--- Number of, ' <br /> Water Su I Public s stem Communit s stem Private. Depth to Water Table'.__.-___ ft. <br /> i <br /> Character of soil to a depth of 3•feet:JSencl j-] Gravel ©� Sandy Loam <br /> ❑ Clay Loa mi ❑ Clay ❑ Adobe Hardpan E] � <br /> Previou 2Application�Nlade: Yes E] No.E] . ; New Construction: Yes ❑. No E] FHA/VA: Yes ElNo �,e <br /> TYPE OF INSTALLATION•.AND SPEC IFi AC TIONS S , G <br /> (No septic tank or`cesspool permit. d if_.public..sewer is available within 240 feet.) ; t <br /> tl- <br /> Septic Tank: Distance from Wearer we€€ - ___ ------------- <br /> -1istance from nfo ndation___�A Material <br /> o. of compa'rtmen'ts-- ��--------- $ize__ __ '_ Liquid de ���� <br /> , -- q Fjh---- ' -------Capacity------- <br /> N <br /> Disposal Field: Distance from-nearest lell ------ <br /> Distance from fo dation_____447 ,-__._.Distance to nearest lot <br /> Number of lines .. ` z . ' �t <br /> Length of each line <br /> ----------- '� - -_------Width of trench------------ ---------------- <br /> Type of filter material_ Depth of filter material__.___,_1�47---___Total length�_______________ �f_n-___'____.____- <br /> j <br /> ti wr ...a.-.. � -:y F.... -s '1r � n.I....�. <br /> Seepage Pit: Distance. to nearest well `-wv :_D.istance from foundation_________________"_.Distance to nearest'lot line__-___..________. <br /> ,. f R ,w.... Depth_ <br /> ❑ Number of pits------ _.. �L �Tmaterrel-- ----- -_ -- Size: Diameter----' _____-. ------ --------------- <br /> p L• Distance from nearest well___ ti�tS_Distance from foundation________ _.Lining material _ ______________ ____F___._---__. ' <br /> : Diameter :- t[epf ------------ h------ ------ -• -- ---------------- Liquid Capacity------------------------F---gals. <br /> Privy: Distance � _ <br /> ance from nearest well. __ ----------- ----_._Distance from nearest buildin <br /> ❑ "'.-Distance to nearest lo# line__ ~�-� -'� :: -------------------- -__ T <br /> e <br /> Remodeling and/or re airin describe <br /> ------------------- ----------------- <br /> ' '"` ------------------------------------ - -------------------------------- <br /> f, <br /> = ----- ---------= t: -_#' Il) <br /> -------------- -=. "-� """= <br /> ----------------- <br /> ------------------------------------- --------------------------------------------- - ----- --- --- - --- <br /> } <br /> 1 hereby certify that I have prepared this apphcatio and-that the v�orrk will-be d�netin accordance with San Joaquin County <br /> ordinances, State lamps. and rules and regulations of the ' n„JoaquintLocal_Heal+th'pisfrict _ _ <br /> a _ t <br /> (Signe( <br /> 9 -- ------------------- and/or Contractor) <br /> BY:-------------------------­ ----------------=- -- - �"" ------------- - Title) ---------- <br /> ------------ --- =------- --=---------- <br /> (Plot plan showing size of lot, location;6f system in relati n to wells, buildings, etc., can a placed on reverse side). <br /> - ( , FOR DEPARTMENT USE ONLY, x <br /> APPLlCA OY ACCEPTED BY "- -�_: ---------------------•• DATE <br /> - - ' --- -` - ----'------- ---------------IDATE <br /> • , <br /> --------------- <br /> --------------Jx�------`- <br /> --- -------•-- •--------- <br /> I I PERMIT ISSUED DATE =----- <br /> ----- <br /> ° 4 <br /> Alterations and/or recommendations:__ __ 1 & 6 <br /> ---------------- <br /> ---------------------------------------------- ---------------------------- --- -------------------------------------------- _---..-------------------------------------------------------- <br /> -------------------------- ---- ---- # ` --------------- <br /> -------------- <br /> - <br /> -------------------------- ------- : <br /> ------- ------------- <br /> --------- = ----------- -- <br /> - <br /> �� - gip-- ' <br /> FINAL INSPECTION-BY: _ Date---------------------------- <br /> - _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r <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 . Revisoa 1-57 RP.00- <br />