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... ... <br /> �.-..-.. - ..-_....-.-- <br /> ------- APt,,,, ;ATION FOR SANITATION PERMIT./ Permit No. <br /> -_...._ <br /> ------- -. ----- _ ............ (Complete in Duplicate) <br /> ......... ................. ...... .I ... This Permit Expires 1 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. ES LOQ( <br /> JOB ADDRESS AND LO ATI/ONa�.'I�ER...._._...17_�U .-.--.-�/,20 -L- L----------------------------------- <br /> ri'Owner's Name_----------_ L 1••../. I�0Qc�f.�.��-- -- Phone------------------------------------ <br /> Address........... <br /> -----------------------------------Address------..... _r . ----:3---- Bvk-------2-3-)------------- =-- ---------------------------------- -------------------------------------------------------- <br /> ,.Contractor's Name_AV__&_N_/91-1 .....:5 E-P,7__I.(_Z_---GER V[C.�.-------- ----------------- ........ --------- Phone----------------------------------- <br /> Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/..... Number of bedrooms_.. Number of baths ._/.._ Lot size ---..:............_------_._ <br /> —Water Supply: Public system ❑ Community system ❑ Private 21--D-epth to Water Table;95 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamlay ❑ Adobe❑ Hardpan Q' <br /> Previous Application Made: (If yes,date.____._.._.... ) No Kj�New Construction: Yes 2--Igo ❑ FHA/VA: Yes ❑ No a' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> `Septic Ta k: Distance from nearest well__.��-----Distance from foundation___ <br /> RQ--------Mater al...�.'0(0ZfR_ �T . ------ <br /> Size_-5____._P/?..9.-__-.__-.-Li Liquid de th..... ...........__..Ca aci .SQ� <br /> No. of compartments..._.�_ q p, p ty_� ._ __.._____. (n , <br /> Disposal Field: Distance from nearest well...SD.._._Distance from foundation---RO.........Distance to nearest lot line_-_�__.------- <br /> WON Number of lines_---_.-_2r_— Length of each line_.5R?__d _y .-._.Width of trench.....%�.�..._.................. � <br /> Type of filter material.. i,...._Depth of filter material..._ --_-Total length..___-._._.._. ___..____.. <br /> N <br /> Seepage P t: Distance to nearest well _/V0......Distance from foundation-__— Distance to nearest lot line__.-._.--__.. 'I <br /> _ Number of pits_..._2-- ----------Lining mate ria l.RO..-Ki.... Size: Diameter._'YY.` ........Dept h.......l-------------..._ <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material----------------------.-_...._.------ <br /> ❑ Size: Diameter---- --------- ---- ---•----------Depth-------•----------------- -----------------------Liquid Capacity. ..-.......................gals <br /> b.Privy: Distance from nearest well.................................................Distance from nearest building_.-.-..................................... --/ <br /> ❑ Distance to nearest lot line-------------------------------- ------------ --•------•-------...-•-•------•---------------------------------------------------_---- - `O <br /> Remodeling and/or repairing (describe):__.. . ... .­­----------- . --------------------•------------------------------------------------------- -•------ <br /> r* <br /> --------------------------- ------......•- --- ------- ....... --------------------------------------------------- -- --- ------------------------------------ ---- :4- <br /> -------- ------------ -- ------- ---- --------------------------------------- Co-------------------- --- - - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin unty J <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. p <br /> (Signed)•-- a --- ---- - ------..(Owner and/or Contractor) <br /> t- 7 <br /> BY ------- I-----------------------------------------------------I------------- --------------------------•--•------------------(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 /> APPLICATION ACCEPTED BY---- ---I--- _ ---��----------- -------- ....... ----------------- --------- ------ DATE------ ---•2----1�J-• _1! 6------ -------- <br /> REVIEWEDBY-----------................................. ---------...---.---- ------- ------_---------------- DATE------------.------------------------------------------._ <br /> `BUILDING PERMIT ISSUED---------------- ---------- ---------------- DATE------------------------------------------------------------ <br /> ----- ---------6Alterations and/or recommendations:...-.-.-----P/TS nob­...... .--- --------------------------------------------------------- <br /> ---------------------- ------------- _-------------------------------------------------------- ..................----------- -- --•--- ----�1 f0-----.................................................. <br /> -------------------- ---------------------- -- ---------------- ----- ------------------------ --------------------------------------------------------- -----------------------------------------------------------_... <br /> row FINAL INSPECT <br /> �� Date....._ ...... <br /> *s <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton 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 />