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i111.114ry di <br /> 9� fix/ f` LICATION FOR SANITATION PEF�T Permit t <br /> li <br /> D <br /> i <br /> lNo. . .11.111--- <br /> (Compete n upcae) F�/ <br /> nj• Date Issued ..._.._l.Y/I_y <br /> Application is hereby made to fhe 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 /> JOBADDRESS AND LOCATION--- .-[ i.. ?Ott. --------------------------------------------------------------------------------••---•-- <br /> .� Owner's Name---------0_1---- ..........................................-------•------- Phone..................— <br /> Address--------- -- --------------------------------------------------------_---- ....................................--................. <br /> Contractor's Name------- .--- ------------------------------ -------- ------------ Phone - - - <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units': ._ i.- Number of bedrooms ..Z. Number of baths .J--_ Lot size ...,100.._,�CIA"Q......----._............. <br /> Wate,r Supply: Public system [[Community system ❑ Private ❑ Depth to Water Table W,ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [r New Construction: Yes ❑ No We' FHA/VA: Yes t❑iiJo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Selytic Distance from nearest well---....-_------Distance from foundation................_Material................--........................--..... <br /> No. of compartments------------- ------------Size...........................---Liquid dep.th-----------------------.-Capacity------.. - ----- <br /> Dis os Field: Distance from nearest well--- Distance from foundation---- -.----------.Distance to nearest lot line. <br /> Number of lines------------------------ <br /> Length of each line-------ZAV,O-----...-.Width of french-----Af?;'0 i <br /> -j Type of filter material-4- epth of filter material....rQ.!y-.......Total length-........ -- -- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation-------------------Distance to nearest lot line----------------- t <br /> ❑ Number of pits......................Lining material...............--.--...Size: Diameter-_------------------.Depth.--------------.----------------- � <br /> ` Cesspool: Distance from nearest well.................Distance from foundation..............------Lining material...........................-......... <br /> ❑ Size: Diameter---------------------- ------_Depth...---------------- ---------------------------Liquid Capacity................ ---- ---gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building....................-.-..-............. <br /> r. ❑ Distance to nearest lot line..........�-y---�---�----------�---�----�-----------------------------'-----------'----•-----•----------------------------------------- <br /> Remodeling and/or repairing (describe):....`....s-....K!I�ti�...-1K/-YLL!(4!j --- ------ -------------•-----------------_.....-----.—__._.- <br /> --------•---- ----------------- --------------------------------I...................... - -------------------- — -- -- --— ---- <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, State laws, and rules and re ulations of the San Joaquin Local Health District. <br /> - ---- ------ —- <br /> (Signed)................... - -------- - Contractor <br /> By:-----------------_- -------------------- - A 2Y6c-..- ---------------------(Title)-------�ZrITZ��LI--:-- ... - _.._... <br /> (Plot plan, showing sae of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> .. FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED Bly�----------------------------------------------------------------------........ ....... DATE=------------------------------------------------ <br /> REVIEWED BY - ---------------------------------------........--- - DATE-sem - — — - <br /> BUILDING PERMIT ISSUED - ----.............----------------------------------------------................ DATE--- -- ------------------------------ <br /> - - - - <br /> Alterations and/or recommendations:--------------------------------....... ......................-.............. ......-...... rP --- --•------- <br /> ------------------------................------- ------------..........................-----......'---------------------........----­---------------- -----------•----•-------—-- <br /> ........................m........-- ...................... ' .................................--- -------------------........................ ----------------- ------------------------- <br /> I --•-----•-•-•--------------...................... • -- ......---------- -------. -......--...-•----................ .............................................------- ........ ._.... . . .. <br /> FINAL INSPECTION BY:------% '.1------- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Stne4 300 Wesf Oak Sheaf 132 Sycamore Siraef 814 North "C" Sfreef <br /> Stockton, California Lodi, California Manfece, California Tracy, California <br /> y ES-9-2M Revises 1-57 F.P.CO. <br />