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rUKUrl-lk-C ubt: <br /> ----- - ----Tj -1 yI (- —� . i, �le, - C, —?, <br /> 6;------- --------- <br /> - - ------ --?.n APPLICATION FOR SAxNIITATION PERM5 Permit No. <br /> -- ------- ------ ----- ------ (Complete in Duplicate) ­714NNED <br /> This Permit Exoires I Year From Date Issued 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION...-Q.Q.I. c, <br /> Owner's Name-----.-rM-_- ------- ------------- _-- - -------------------- Phone-----------------_--------- <br /> Address--------1?.:t 3._I1__Ra_?L <br /> Contractor's Name---------------\:,Z, <br /> .l_*v-------- t ..-------------------------------_-------------.------------------- --------------.. Phone----------------................. <br /> Installation will serve: Residence Ej/Kpartmenf House E] Commercial [] Trailer Court E] Motel E] Other [I <br /> Number of living units: ._)._.- Number of bedrooms _Z__ Number of baths Lot size --------- Ac—ir?---------------------------------- <br /> Wafer Supply: Public system E] Community system [] Private ER'beloth to Water Table <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] Ian y Loam E] Clay Loam E] Clay E] Adobe 2"'Hardpan 0 <br /> Previous Application Made: (If yes,date__.... .._......) No gr New Construction: Yes [f No ❑ FHA/VA: Yes [& NO El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well -:5— --Distance from foundation---14---t------MateriaL_.&&_9 -------------- <br /> No.,of compartments--- --------Size_.�L_1_1S_]1­!y_0_"Liquic1 depth----44�-- ------ Capacity_.j..\_'.L,__Q------- <br /> D;sposalField: Distance from nearest well- �_6 Distance from foundation.-It............Distance to nearest lot line-.S.......... <br /> Number of lines......)I,--------------- -----.Length of each line--- ------Width of french—D.V-4------ -------- <br /> Type of filter material..-1 LZ!,_k; %l Depth of filter material--.- _%ot.------Total Iengfh___,Lj,3a2____4_(... <br /> Seepage_FO: Distance to nearest well- .......Distance from foundation....../R-.-.....Distance to nearest lot line-_S <br /> Number of pits_^,)l,___ -,------Lining matferiallilac-V Size: Diameter_3_3_�e__ _. Depfh_j__S___ <br /> Cesspool: Distance from nearest well.. --Distance from foundation ----__Lining material__...__-_----------__...... <br /> F1 Size: Diameter-- -- - ----------- .... --- -- ---Depth-- --- ------ -------------- ...... -Liquid Capacity-_.------------------..gals. <br /> Privy: Distance from nearest well.__....._._.._-._------- -Distance from nearest building...__.------.__._._---- --_-_-.ie <br /> F1 Distance to nearest lot line.-, <br /> -------------._.....----------- <br /> Remodeling and/or <br /> I---a--n--d--/--o--r---r-e--p--ai-r--i-n--g-----(d---e--s-c--r-i-b--e--)--:---,---------------N--­---o-­w----,-------------------------------------------------3.----,-"-I--------- <br /> ---L--------------------------------------------------------------------------------------­------------------------------------­­----------------- ------------w­----------------------:------- .. .. ------ -------------- ----------------- - ------------- ------------------------- <br /> - <br /> ---------- <br /> ------------ -- <br /> --- --------- -------- -- --------------------------------------------------_-------------------- -------------------------------------------------------------- -------- - ------- - <br /> I hereby certify that I have prepared thisapplication and that the work will be dome in accordance with San Joaquin County <br /> ordinances, State laws,and rules and regulat <br /> ions of the San Joaquin Local Health District. <br /> (Signed)-------------- ----- ----------- - --- ---- - ----------- ----- ----- (Owner and/or Contractor) <br /> By:---------------------------_.. - \J_� <br /> n of sysf em-in----- ------- ...(Title) <br /> (Plot plan, showing size of Ics anon re ti, to wells, buildings. etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ --- ------- --------------- ----------------­ DATE----- I <br /> IZZ- j,----------:�t_ <br /> REVIEWEDBY-------------------------------------------- ------ -------------------_-L-------------_ DATE.---- ------------/---------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------—--_---------------- --------------- DATE-- c---...... _1_A_ <br /> Alterations and/or recommendations:------- F-- --- -------- V <br /> ------ -- _-- <br /> .......... - - -.- -- <br /> - --- ------ <br /> - <br /> --------------------------------------------------­-----­--- ----­ ----------------------- -------------------- ----------------......... -------- ------------------------------------- <br /> ----------------------------- ----------------- --------------- --- ---:----------------------------------------------------------------- ------------------- ----­----------- --------- <br /> ..... .. . . ........__ - ---------------- ------- --------- ------ --------------------------------------------------- ------------------ ------------------------------ ................... <br /> FINAL INSPECTION BY:-,..... --------- Date-- -- ----- /Ky <br /> -- ----- ---- <br /> IN LO <br /> SA JOAQU CAL HEALTH DISTRICT <br /> 1601 E. <br /> H..elt.n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br /> bi <br />