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/ 'LICATION FOR SANITATION PEF 'T Permit No. ..-lt. _......._.. <br /> Y v F <br /> /f (Complete in Duplicate) <br /> Date Issued <br /> Applica�ion 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 /> .c.�?. ,! '. `.......--.........---------------------------------------._------ <br /> JOB ADDRESS AND LOCATION�__/..��...��..._.._...�.....lr,�' ... -- ---�4� <br /> 7J1 19s °J .. Phone......-........................ <br /> - Owner's Name----------- �'r�--'----- •--------.-/ • -d"�=-------•-------------- -.............. _.. ------- -------- ------ <br /> Address.-•-------•---�"1''L. .... ............... ..... --- <br /> Contractor's Name - Lf f €�f... =- r ... Phone.............---------------- <br /> Installation will serve: Residence gj�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._.-_ Number of bedrooms -7.. Number of baths ..Z.. Lot size . ........................ <br /> Water Supply: Public system [I-"Communify system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�lardpan ❑ <br /> Previous Application Made: Yes ❑ No P�-- New Construction: Yes ❑ No gg— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well.................Distance from foundation_...................Material--------................_::_..-.._-------..._._ <br /> No. of compartments. --- .---. ...Size----------------------------Liquid depth..........................Capacity--------------------- <br /> Disposa ield: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line........_- <br /> Number of lines.....................--------------Length of each line..............................Width of trench......................_........... <br /> Type of filter material.....---------------....Depth of filter material-----------------------Total length.....................__-._.._-........... <br /> Seepage Pit: Distance to nearest well---)UW4t'Distance from��f�un,od9 Ion J ....Distar�� to nearest lot line_.�I ..�...- <br /> Number of pits------L._------_Lining material.�48 ze: Diametey -�-----..----Depth---O ..fes._.....-.._._._.._. \ <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------......Lining material---------------._..................... <br /> [ <br /> ❑ Size: Diameter.-- .--------------------..-_.Depth-----------------------------------_---------Liquid Capacity............................gals. `N <br /> Privy: Distance from nearest well------------------------------------.------------Distance from nearest building..........._.........--__............ (� <br /> ❑ Distance to nearest lot line----- .. -- a- .. ....:_............------------------------..-....--...... kt <br /> Remodeling and/or repairing (describe):_..--.-.,.-.-----C�, `FG��'•Y"'"--f1.:8�E?:r.......--L S.�.- a �rsrt -- •-------- ............... <br /> .......... --..........................................................................___..............----------......................... .......... -------------------------------------------------------- <br /> -----------------------------------------------------------...............-----------------------------------------------------------------------------.................................................................... <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 regulations of the San Joaquin Local Health District. <br /> [ _ ��✓• t/S-'""�-'sem _ _.:.. Contractor <br /> (Signed)---...----- e 1 '(�` - <br /> By:••••. _....... - ! ° � ................................(Title)--`-,;C .� r flr.<':. <br /> (Plot plan, showing size of lot, I tion of system in relation to wells, buildings, eta, can be placed on revery§ side) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -... -- --........ - - ..... -.................. DATE-- ! - - - <br /> REVIEWEDBY------------------------------------------------------ - - -- -- - -- DATE. - -„ ...- - ......_..._...._....... <br /> BUILDING PERMIT ISSUED_............................. - - DATE-.-...... • . ................ <br /> Alterations and/or recommendations ................... ... <br /> -.................... -- - 4 ----------------------------•--- ----•-•--- - -- -- -- ------ <br /> z �:�: T _:.---.-- ..----••---------.........................................__............................-- ...._... <br /> ... - <br /> -------------- �- ..... <br /> - -----------...------------......._----_--------.. . ....---------- ..............................--...................--------•--........................... <br /> - - --- -----------................................................................. •-------.....------....................................... -------------------------•------------•----- -- <br /> FINAL INSPECTION BY:.__�r / <br /> Z--/7 �-�� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes} Oak street 132 Sycamore Street 814 North "C” Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> – ES—s ia�..-s A-rn000 <br />