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<br /> ........................ ......... .
<br /> APPLICATION _
<br /> • � Ffll�' SANITATICJN PERMIT Permit No.
<br /> .......,.-...................................._... (Complete in Duplieata)
<br /> This Per >x fres i Year Froin Data tssufad Date Issued
<br /> Application is h0reby.made to the San Joaquin Local Health District for a permit to construct and install t' work herein d
<br /> _This_application•:s.made.in,compliance with County Ordinance No. S49, escned.
<br /> JOB ADDRESS AND LOCATION.�" ',f~�,� _
<br /> Owner's N
<br /> J""�,/�, r�✓ f Address _. _....
<br /> .___-- .� .� �-�.tt�.<�"'✓.f.�./..?`_.... Ong'_..._..»,»..................._._.,- 9
<br /> ,V; .1._.._. ...
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<br /> Contractor's Name_.... '' t- ?y�!• -- 1 ,�' .........
<br /> ...........
<br /> " _,.-....- __._...._...._... .
<br /> ........ Phone.......
<br /> Installation will serve. Residence ❑/Apartmerif House ❑ Commercial Trailer Court ❑ Motel
<br /> ?! i� t
<br /> / Other ❑
<br /> Number of living units: ......' -. f'1i;mber of'b"r rns.!gym Number of.baths , �/�1L•• ,�_�•
<br /> Lot sizer+,..,.
<br /> 1
<br /> Water Supply Public system ❑1Commun�%rsystem Q-,�Privata epfh to Water Table :t. _ !
<br /> Character of soil to a depth of 3`feet: Sand ❑ Gravel andy Loam❑ Clay Loam ""•Clay❑ Adobe❑ Hardpan❑ �
<br /> Previous Application Made: No New Construction: Y,--s fZe'No [:1 FHA/VA- Yes E] No �--
<br /> TYPE OF'INSTALLATION ANt� SPECIFICATIONS:
<br /> {IVa septic tank or permitted p�rmitfed if public sewer is available within 200 feet.)
<br /> Septic Tank Distance from nearosi wel!_f�,4?,•Distance from foundation---
<br /> �r ,No. cir'-compurt> nis.. -... ..Size X�<../r.12. depth......�wi
<br /> �r
<br /> Disposal Field: I3 sTance 401 haarest we!i-�4......Distance from foundation•„ i G../.....Distance to nearest lot Iine_ e ✓
<br /> Number of lines, �`
<br /> ' -.. may/ engtn of each line.... __.Width of trernch. �_,..... .._... ._.
<br /> ,.qr
<br /> Type t' filter ma#oriel�'.- �/ De th of filter material.--.,rte `
<br /> t � p ,..,�►!., .Total
<br /> Seepage Pit: Distonce to nearest ell.._f'dL9.� Distance fry�n fo dation.r_!',t��t'�._.r,.Di 1t nc to nearest lot line.fL"..�_.-.J.•
<br /> Z""~ Nurtlier of pits._. _. .••.._Lining material._ .5izs: DDepth__
<br /> Cesspool: Disf4co from nearest well................Distance from foundation.,...-.._.._...... Lining
<br /> [] Size. iamefer.____... ..... _.—Depth.—........... ........... ._....Liquid Capacity- 9 els.
<br /> rivy: Clistance ?rvm newest we ...
<br /> ll -.««._�............. .W.......... . .Distance from nearest building._._....
<br /> I i ..... ...-.-.._.- .....
<br /> ❑ ' D;sfart ce., 'to neare�st lot lil`A..,_.--___-•„.................._.,.........._........ __-_--_- _ .,,.... .. « .. ........«_.,...-......
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<br /> Remodeling and/or repairing
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<br /> I hereby cortcfy that I thaw prepared this application and that the wort:will be done in accordance with San Joaquin County
<br /> i ordinencas, State laws,"and.t s and regulations of the San Joaquin Local Health District,
<br /> _. -.
<br /> y . . .. .......-_........................ . ..-.pr Contractor)
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<br /> y• - ,j�w�"Y✓ t
<br /> ................>�,_.......
<br /> (Plot plan, showing size:of lot, Iacaf"ori of sysf re ation to wells, buildings, etc., can be placed on reverse "side}.
<br /> L,.
<br /> _. FO DEPARTMENT USE ONLY +
<br /> APPLICATION ACCEPTED BY 07J i - � s
<br /> ...............««._... DAT d 6
<br /> REVIEWED BY E t..« .' _ .•-....__. i_....
<br /> __._. _ ................... .. DATE;.._._..« ....»,....... _
<br /> BUILDING PERMIT ISSUED_......._,.--.....:,. .. DATt- I
<br /> Altera
<br /> frons"and/or recommendations: «.......
<br /> ...
<br /> .............. ........_:..Y.. .. ........ _-_._.__..... .........A.......................... :~.: ..............
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<br /> ...........I.......... . _._ ._...`.._.......... . ......._...................«...............,,.....
<br /> ..�......._ «... ..»,. .. _...._-•.....��._.._. �_._....,
<br /> FINAL INSPEE-CTION BY:. . .
<br /> .._.. . `�(� •�'�..»....._. Date.......... .,/_.....fv...-;i:.�...«..............................
<br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1601 F.l ctralton Ave. 300 Wort Oak Stre.eix
<br /> 7 24 Sycamore Street k 205 Wast 4r6 Street �
<br /> Stockton,California t Lodi,California 1 r�anteca,'cai'rfornia 1 /racy,California
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