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ry�K Urrlct USE: - `- <br /> APPLICATION FOR <br /> -------- -.�--tet .................. SANITATION PERMIT Permit No. .-1..��.�_�:�I <br /> -------- - --------. ­.................. ------ (Complete in Duplicate) ` <br /> ..--'.`.-- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh 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 /> JOB ADDRESS N CATION...... /. <br /> Owner's <br /> Q ----ff"/�J.�--- ------ - ---- --7--•------•....................._------------- Phone..-.-----' -- <br /> --- ------•-------------�- <br /> jV - y /r.c.r_-�c�. . . ................. <br /> Address----------............. �� :.. <br /> Contractor's Name. ............................. Phone............-------- ...... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- --- Number of bedrooms ._____ Number of baths Z... Lot size s�27, 4'�..- -_.-_- <br /> ----------------•- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -44� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [L-Hardpan ❑ <br /> Previous Application Made: (If yes,date............ ) No Ua'--New Construcfion: Yes ❑ No 2?'_FHA/VA: Yes ❑ No K�-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t <br /> Se tic T"an�: Distance from nearest well.................Distance from foundation----------- ------ Material-_......................... <br /> I <br /> LSA-f,,�9 No. of compartments ----- ' Size------•- .........•.Li uid de th------------- Ca aci <br /> Disposal Field: Distance from nearest wet(.._°`..t-- --Distance from foundation...<® ... Distance to nearest I� line���... �- <br /> Number of lines.......... ...f.. Length of each line.. Width of trench.-Z-/--- --- .---------------- <br /> 01( <br /> lType o.' filter material-Y 1J C�Depth of filter material._ .....Total length dor 00 , <br /> Seepage Distance to nearest well.....__..-......___Distance fr m fo clafion_.. ?19......Distance to nearest [of li e.�---------- <br /> Number of pits------- -----------Lining material.-, ee Z.Size: Diameter.���......._.Depth,��, <br /> Cesspool: Distance from nearest well...... ...._Distance from foundation_ ... ............Lining material.........._:-------------------- <br /> .--_- r <br /> ❑ Sizei D;arneter._.. ........... Depth ------•-•------............Liquid Capacity.......... <br /> •-•-------------gals. <br /> Privy: ;Distance from nearest well- --------------------`........_..--_-......._.Distance from nearest building---I......._._._._......__..... <br /> El Distance to nearest lo? line............... ................. �... ` - -:..... <br /> Remodeling and/or repairing (describe:..................��.. ....-F,�::.'-af���!'�.` <br /> ..........................•------------------_ -•---------------------_.........-----_._..._.------------ --------------------- ----------------.......... ----------------- <br /> ------------------------ ------------------------ ---- --------------------------------•----•-------------------------------- <br /> ---------------------------------------------------------- <br /> ­_ ------•---- •----------------- ----------------------------------:_.-...--•-----__-------.--*----------- -------------------------- ----------------------------•-------••------ -------------------------- <br /> A <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 regulatt ns of the San Jo u' Local Health District. <br /> (Signed) . ......----- - -------------- Dr Contractor) <br /> 8Y - (TifIe).- t/� - - --- <br /> (Plot plan, showing size of lot, location of system in relati 0 we s, uildings, etc., can 6e placed on reverse side).: <br /> FOR 6EPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED By......... .--.- .. . ............ -- DATE-------- n'� � , <br /> REVIEWEDBY._... _ .. ...----------------------------•------•--..................... DATE---- •---._...-•---..._..... <br /> BUILDINGPERMIT ISSUED.---------------------------------------•---•-•--...........----------•......... .. .. ---------- DATE.........------- ---•-- <br /> Alteretionsand/or rec n ndations:. .............................._......-•-•--•-•---------•-------- -----------•------•------.....---•-------- ........_... <br /> . ...a s.�..6 - �f��`' -L�3��....-•---•-----------••---------------------------------- <br /> --------- -------------------- -------- .................................................................................................................- <br /> ..-------- . . ..--:-----•--._.....-•-•........................................•--------------------------------...................... .................................................. <br /> -- -------------------------------- -- _.------------. ------. . ----•---•---.........--••- ...-...................................................................................---.......----.......- --..._....--- <br /> FINAL INSPECTION BY:- ---- - --------------- ............... Date...... 42, ��.�_-�p. ._...... .._.... <br /> SAN'JOAQUiN LOCAL HEALTH DISTRICT <br /> 1601 E.Haiettan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California ' <br />