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-7j <br /> ........ 11CAT ... <br /> FOR SANITATION PEP 7 Permit No. ..... <br /> -/07 *400 <br /> See3D------- —'(Cornplete in Duplicate) Date Issued --- <br /> aThis Permiftxpires 1 Year From Date Issued <br /> ----------------------------------- -Zi��Or----- --- <br /> L­App Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> T �,�,o <br /> This application is made in compliance with County Ordinance No 549 <br /> JOB ADDRESS AND L AND ---,- ".w�41!: - ---------------------------------*-------------------------——---------- <br /> Owner's Name_. ._. ....... ----------------- -------------------- ... .................. Phone........................... <br /> Adclress----Ied�----- ------------------------------------------------------------------------------------------------- <br /> Contractor's Name.-----M;�" ..................................--............................................... Phone.---•............................. <br /> Wee <br /> Installation will serve: Residence ®Apartment House [I Commercial (3 Trailer Court 0 Motel ❑ Other [-I <br /> Number of living units: --Z.. Number of bedrooms Z-- Number of baths Z.. Lot size - <br /> be ------ <br /> e Water Supply: Public system 12*`Eommunity system 0 Private [I Depth to Water Table .4l <br /> Character of soil to a depth of 3 feet: Sand [j Gravel [-] Sandy Loam E] Clay Loam [] Clay E] Adobe U? (hardpan 0 <br /> Previous Application Made: (if yes,date....................I No g?' New Construction: Yes C] No kp/FHA/VA: Yes [I No Q-- <br /> TYPEOF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic Tank:, Distance from nearest well.................Distance from foundation---................Material...-.............---------------------------- <br /> Wes .ifi No. of compartments.... ---------------------Size........-----------------------Liquid depth--------------------------Capacity----------------------- <br /> Dispos4 Field: Distance from nearest well........_Distance from foundation../A..........Distance to nearest lot line.b:r .... <br /> Length of each line-----------------......Width of trench-.Ve <br /> Number of lines....... ----------------------- <br /> ----------------------- -j <br /> Type of filter material_ -04o Depth of filter material-4410;*.......Total length----- <br /> rp <br /> Seepage Pit: Distance to nearest well........!n..........Distance Zfr fo ndation,-Jra.-� Distance to nearest jpfline..S.1�-, <br /> 00 <br /> Number of pits-------/-----------Lining material- j'a-.T -.Size: Diameter-0 Depth- <br /> Cesspool: Distance from nearest Weil..............._Distance from foundation-------------------Lining material.___........._._.._..__.___----------- M <br /> El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- --------................gals. <br /> Privy: Distance from nearest well.................................................Distance from nearest building__._.__........---------._______..:... <br /> ` <br /> uilding..............------------------ <br /> bee <br /> 0 Distance to nearest lot line................. -------------------------------------------------*------ *--------------------------------------------- <br /> 1^ J017 e V1 <br /> 'Ar4V -- -*.......------------------------------------------ ----- <br /> -- <br /> Remodeling and/or repairing (describe):......... <br /> Nee ......... ----------------------------------------------------..............................----------------------.........--------tx�--------------------------------------................. <br /> ......I--------'--------"------'--'------------'----------.....--•-•---.......................................-----------------------------------------------—------------------------ <br /> -------------------------.................--------I------------------......................... ..............I.................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 regulations of the San Joaquin Local Health District. <br /> (Signed)--------...--- e-" ---------- - r Contractor) <br /> i�- ------------------- - <br /> By:-------------------------------------------------------------- .............(Title)- .VV&/'s--X <br /> elation f <br /> (Plot plan, showing size of lot, location of i '*o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - - -------------.............................................. DATE. —Z3�4 <br /> -7........------------------ <br /> REVIEWED <br /> ........................... <br /> REVIEWEDBY--------------------------------------------------------------------------.........................-------................ DATE....................... ----------------------------- <br /> BUILDINGPERMIT ISSUED.--------------'--------------. ------------------•-•--------------------................. DATE............................--------------------------- <br /> Alterations and/or reco mendatiops:------ <br /> ----------- --------------------------------------------------------—....................I........................—-----....... <br /> ------ --------------...................................................I-------------------------------------- <br /> lees ..........�3 <br /> A---------------------------------------------------------------------------------------------------------------- <br /> ---- ------W- ------------------ ---------------------- ..................... ------ ----------------- <br /> -----------------2------ --- - ---------------------------------- <br /> ----------------------------------------- ...................------------ -- ------------- --------.......................-......... ....... <br /> tees FINAL INSPECTION BY:.._.-c�vlo �----------------------------- Date------- ..- .^.: ......_ . . ....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Its 1601 E.Hatrellon Ave. 300 West Oak Street 124 Sy,cnn.,e Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca,California Tracy, California <br />