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FOR OFFICE USE: --... . -_h_ - ` ' P APPLICATIONYFOIL SAN17ATlON PERMIT Permit No. . 8`J� ._. --------- --------------- ----------------- - {Complete in Duplicate} Date Issued 1. '�� ___' __� ;This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#all the work herein descrbed. This application is made in compliance with County Ordinance No. 549. - . 1 �--- �. - - .----- JOB ADDRESS AND LOCATION_.-_ ---------� -----�-�---------- -- -- --• - _ ` i 7Phone t ..... Owner's Name -------•-- - 4 1 ' Address.-fi,r.. & -- F 1 -d3 + a F ` , ------------------------------------------ ------•---------- Contractor's Name---_ Phone...-- .Zt Yt�2 Installation will serve: Residence %L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. .._-_ Number of be --9..r- Number of baths I.... Lot size �._�----- -• --A-------------------- Water Supply: Public system ❑ Community system ❑ Private%L Depth to_Water:Table ...... - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe C5 Hardpan ❑ Previous Application Made: (if yes,date-_.---------------- ) No ❑-= New Construction: Yes-E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200-feet.) _ P Septic Tank: Distance from nearest well_ .Q__-Distance from foundation-----14------.Material._-... ��...- --........-,............... No. of compartments.- ------:,�,- ---Size-------------= - -----------Liquid depth... -- -- ------ ------- Capacity---- /0 apacity- �� � ...-_.Distance #o nearestro lipe.-_sr� ._._... Disposal Field: Distance from nest well..... 1-_Distance from..foundation„- ....- Number of lines -.Length of each R &) Width of trench._ _.-a............._-------- ❑ -- Type of filter material.-- ..(.Depth of filter material--- .-.,� _.-.-_Total length...._ .. ._�------------------ Seepage Pit: Distance to nearest well-.-......___....____.Distance from foundation.-.:..�-.._._...__.Distance to nearest lot line------------------ Seepage Number of pits.-- ------------ --..Lining material------ ------ Sizer Diameter-----------------------Depth_..-------.------------------ -- Cesspool: Distance from nearest well ----------------Distance from foundation-..-_._-------- -.Lining material....____.___....-.-.-......._:...-... ❑ Size: Diameter- -- ---------- - Depth-- ---------------------------------------- ------- Liquid Capacity gals. Privy: Distance from nearest well-------- "-"`--_:"____.-. _:__ _Distance from nearest-building------------------------------------------ Distance ........____....................._----- Distance to nearest lot line .-- ---_------- -------- ------------------- --------- ----------- ------- Remodeling and/or repairing (describe}------------------ ------------------ ---------------- ----------------------------- •---_---------------------------- ----------------- -------------------------------------- ---------------- i - ----------------------------------------------------------- - ------- ------------------•-------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County� _a ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed]. ___ .f -__-.(Owner and/or Contractor) By: ------- ----- ---------- ------------------ ---- ----------------------- --------- {Title)--------- ------- ------- - - - ------- --------- (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R EPARTMENT USE ONLY APPLICATION ACCEPTED BY,^ ..... ---- ----------------------- ------- -------------- ------- --�---------=DATES . �'-s�� REVIEWED BY. = ----- - ------ ------------ ---------- ------ DATE ----- - - - -- BUILDING PERMIT ISSUED_.- ----- DATE - - Alterations and/or recommendations:------------------- - - ----------------- I - --------------------- ------- ---------FINAL INSPECTION BY---------- --- -_------- ----------------------------- SAN ----------- -- ------------------ Date-------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hamilton Ave. 300 West_Oak Street . ,_ 124 Sycamore-street- .- _ - ---=-205 West-91h-Street -a - Sfocklon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press