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- i : . APPLICATION FORNITATION PERMIT Permit No: ....7L_S�- Com Ie in Duplicate) t. .. Date Issued .----f---------------- Applica,lion is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. JOS ADDRESS AND LOCATION----`' _ . - - -- __- -----�•---------�-------- '1 > ._S r`_ 7ne - �- �-s G Owner's Name...y� �� '-' r Address___----- .- -------- ------ Contractor's Name- _ -- � r6 = y ,7-------------------- --- Phone-- -o- "-- -_-_--- =: �)K Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer 'Court Motel ❑ Other ❑ Number of living-uni#s: -------- Number of bedrooms ________ Number of baths Z�--Lot size ________ I. Water Supply: Public system ❑ Community system ❑ Private$29--Depth to Water Ta blePjftP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel JS Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No EL New Construction: Yes C No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public kewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well-. istance from foundatio ../.............Material--- No. of compartments--------- ------------ -------�----'---- •- z c,-.� ------- - -------Size�j�__xS'�s kid depth------�-11----------Capacity.__,P___4!:V Disposal Field: Distance from nearest weli__A-f--I-A.vAktance from foundation--- __-------Distance to nearest lot line___- j�( Number"i lines__________ �____---.____Length of each line--------t�-_-__-Width of french...... � ______________ ; Type or.,filter material-.'_ _...,�,4c_'Depth of filter material-_-_f -----------Total length------ - - ------------._ I rDf59ance r m foundation_.. ._____.Distance to nearest lot line___ Seepage Pit: Distance #o nearest well__ ,(� V1 X, Number.,of pits------ ------------Liming materialDiameter-----G -------Depth--- - ----------------- Cesspool: --------- ---Cesspool: Distance from nearest well-----------------Distance from foundation___------_----------Lining material_________.-__-________._______..____. CJ I ❑ Size: Diameter----------------- -- --------Depth •----------------- ------ ------Liquid Capacity--------- --•--gals. Privy: Distance from nearest'well-----------.-------------------_ -----.__._Distance from nearest building---------------------------- - ElDistance to nearest-lofline=----+------------------------------------------------------•------------------------------------------------------------------------------ Remodeling and/or repairing (de scribe):_...____._-------i ------------------------•-------------------------•-------------•----------------------------•------ ---------------------------•--------------•-------------------------------------------•-------•-•---•--------------••--•-•---------- ------- I hereby certify t I Have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State wd 'rules and regulations of the San Joaquin Local Health District. �.,,/- (Si n --------- -- ------ --:-cam -----------x - ner and/or Contractor) 4 �- -- BY �' "` J t �`�� 7. (Ti#Ie} -- - -`------ ------------------------------- (Plot plan, s owing size of lot, location sof system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY_ ---------------------------- --------------------•-------------------------------------------------------- DATE_ -------•---•-- REVIEWED BY_ ----------- -------- 1!--- ---- ---- - ----- - ---------------------------------------------------------------------- DATE---(__------- ._... BUILDING PERMIT ISSUED------------- ------•-----------------------------------------------------------------------._..__ DATE-------V%� 6�: Alterations and/or recommendations:. .......... -------------------------------- -----•----------------------------------- - ------- -----------•- ------------------------------------------------------------ II -----------'--------------- 'I-------- -----------------------------•-...- --------------------------------------•------------------------------ ------ FINAL INSPECTION BY:_'f Date ----------`-`-------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street , Stockton, California Lodi, California Manfeea, California Tracy, California r ES-9-2M 145446 ATWnDD 12.54 P