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Permit Na <br /> APPLICATION FOR SANITATION PERMIT Date Issued -- --7 <br /> --- - <br /> (complete in Duplicate) <br /> permit to construct <br /> I a a "5c"' <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct a d 'install the work herein described. <br /> This application is made in compliance with County Ordinance N 549. -- ----------------------- <br /> -------- -- -------- <br /> JOB ADDRESS AND C TIO - --- ---- --------------- ...... . ... ............ phone -—--------------- <br /> --- ------ ----- ----------------- <br /> ------- ----------------- <br /> - ------- --------- ---------------------------- <br /> Owner's Name---------- ------------------------------------------- <br /> - <br /> ------------------------------------- <br /> 7rS <br /> Address---------------- ---- -------- <br /> --- Phone <br /> Contractor's Name------------- --- ---- Trailer Court [3 Motel [I Other C] <br /> Installation will serve: .Residence Apartmentuse 0 Commercial 0 - ------- ---- <br /> rooms ----/.- Number of baths _/--- Lot size ------- ---- --- --- <br /> Number of living units: Number of bed ate ❑[3 Depth to Water Tabl-l"ff. <br /> Water Supply: Public system Community system 0 Priv 117------- <br /> X Sandy L66m [T Clay Loam [I Clay E] Adobev Hardpan D <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sa I No <br /> Previous Application Made: Yes [3N <br /> New Construction: Yes <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> permitted if public sewer is available within 200 feet.) <br /> (No septic tank or cesspool P stance jrom foVdat;on-_,/-&1- --Mate;ial--- <br /> Distance from nearest w)el st / f- �-�_ Lil _ ______ - - <br /> ____ --I- quid dep�h --hapa ��y <br /> Septic Tank: ;_/_ tze-_ loqm <br /> No. of compartments_"___ _.- <br /> Disposal <br /> - ------- --------------------Width <br /> isiato nearest lot line---------------- <br /> D Field: Distance from nearest well ----------------Distance from found afi-on--------------------Width of french._------ -------------- -------- <br /> or lines----------------------------------Leg------------------------------Length of each line- --- --- ----------------------- <br /> V Number I aterial--------------- ------Total length------------------- <br /> __X 1�7,/; Type of filter material_____-------------------Depth of filter rn ----------_----- <br /> f from foundation------------------- <br /> Distance to nearest lot line <br /> Seepage Pit Distance to nearest well----------------------Distan I ce --------------------------------- <br /> Size: Diameter----------------------Depth <br /> Number of p*jts----------------------Lining maferia --------------Lining material------------------------------------- <br /> N Cesspool: Distance from nearest well-----------------Distance from foundaflon------ �*tquid Capacity----------------------------gals. <br /> Diameter--------------------------------------Depth---------------------------------------------------L <br /> -Distance from nearest building--------------------------------------------------------------------- --- <br /> Privy: Distance from nearest well--------------------------------------- ------ ---------- -------------- ------------------------ - ---- ---------------- <br /> Distance to nearest lot line--- -------------- ------ ------ - ------------------------------- <br /> i <br /> -------- <br /> ❑ <br /> materia <br /> Ing------ ------- ----------------------- <br /> - ------------ <br /> ---- ------ ---------- - ------- -- --- ----- - <br /> ------------ --- <br /> e ------------------ <br /> Remodeling and/ repairing (describe):-_- ---- --- ----- -- ------- - ------------------------------ ------------- <br /> ------------------------------- <br /> ------------- -------------------------------------------------------------------- ------------------------- --------------------------- -------------:-------------------- <br /> ---------- ____V----- ------------ <br /> ------------------------------------- <br /> ------ ---- - ------- <br /> ---- - -------------------------------------------------------------------------- --- ------------------------------------ --------I----- ---------------- --------- <br /> -----­-------------------------------------------------------------- <br /> -- --------------------- - -------------------------- <br /> ---- --- --------------------- that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application and <br /> ordinances, Stat ' s, and r es d regulations of the San Joaquin Local Health D.istrict. <br /> 7_� r Contractor] <br /> ------ ------------------------------------------------------------(Owner andlo, <br /> - -- -------- <br /> ---------- ----- <br /> (Sign <br /> - e, <br /> ed)------- ------- (Title),,--,- <br /> --------------------- i;5 e side]. <br /> ------------------------ rs si e). <br /> BY---------------- - - .._____ . etc., can be pified on revers <br /> 3 kze 0 location of system in relatiton to wells, buildings, <br /> (plot plan, showing of lot. loc <br /> FOR DEPARTMENT USE ONLY <br /> —--------- <br /> DATE - <br /> APPLICATION ACCEPTED BY - ---- --- - - ------------- ---- <br /> -------- D <br /> ATE- :--- <br /> REVIEWED BY-------------------------------&-- --------------------- --- DATE- - <br /> X----;---------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------- ----- ----------------------------------------------_--------_ <br /> zzz <br /> ---_---_---/-- <br /> ----------------------------------------------------------------------- <br /> - <br /> -- <br /> - <br /> -------------------------------------------------------------------------------------------- - -I V------- -----_-----------�----------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------_---------r------Z <br /> Alterations and/or recommendations ---------------- ------ ••_-_----•-- <br /> ------------------------ ------1----- --------------------------------------------------- - Z---------------------- <br /> ------------•--------------- <br /> ---- <br /> ----------------------------------------------------- <br /> - <br /> - <br /> -------------- ---------------------------- ------------------------------------------------------------------------------- ---------I------------- ---- <br /> ----------------------------- ----------------------------- -------- --- ---- --------- <br /> R - - ---------------------------------------------- <br /> �-Au[[------------------ Date-."------ <br /> INSPECTION BY:_.____- - <br /> SAN <br /> Y-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 13o South American Street 300 West 00k Street Manteca, California Tracy, California <br /> Stockton, California. Lodi, California <br /> W-2100 <br />