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F" FOROFFICE USE: - -------------- ................ "--------------- APPLICATION FO - S?iN''ITATION PERMIT Permit No. ---- (Cornplate•in Duplicate) Dafe Issued --- - ._ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Or • n No. 549. JOB ADDRESS A OCATION ----- - ----- --- ------ Owner's Name----- ------ ----- "----- -• •-- Addres--------- t` -------- ---- t ------- - Contractor's Namel`_ - , --- -CL" ------- ;�--1•------------------------ Phone..��9t�•` 7 Installation will serve: Residence [g Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/.... Nu er of bedrooms Number of baths 4 - Lot size -- a--�- -------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand [j Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Ll Adobe ardpan ❑ Previous Application Made: (If yes,date__.-__-_.......... ) No ❑ New Construction: Yes ❑ No5e__FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or-cesspool permitted if public sewer is available within 200 feet.) is k: Di tante from nearest well.-.--._-____-...Distance from foundation_._................Material ...........---.___.___-.___..___.___.___.-... No. of compartments---------- ...---Size--------------------- -----------Liquid depth------ - --- --------Capacity------- --------------- D' osal F'.eld: ince from nearest well-/`10—_4 -Distance from foundation---- (-..--..Distance to nearest lot line................. Number of lines --... .... _.... . . __.._Length of each line--- <0.-�....... Width of french.__ �r.... ......... '� Type of filter materi Depth of filter material -.__-W�J Total length..._....-.- ---------------- ;W11 ............... ---- Seep e Pit: Distance to nearest we L_/_ '._.__.._---- om foundatio �........l7ist �e t�7 Barest lot e................. ` 01 ------------IH material Size: Diameter- -...._. F ldaficn kCesspool: Distance from nearest well . ..': -_--_.-.Distance from .............�... _.Lining mat erial........_-__.........-.-- ----.--- ❑ Size: Diameter- -- --------- ----- - - '.........Dept h---=------------ -------- - - ---- .--.--- ------.Liquid Capacity" " gals. Privy: Distance from nearest well_A... ........... .. ..................' _.Distance from nearest building--------- ------------------------------- =: Distance to nearest lot line -�"-�----"----------� "-"---------�y--�"T-.�`-'i-----------"-------- -- - --- ---------------"----"-"----"----- - Remodeling and/or repairing (describe) -------------------------------------------------- ----------------------------------------------- ----------------------------- ----------------------- ` ----- -------- - --------------- ------------ �" "------------ --------------------------------------- ---- -- _---------------------- ------- ------------------------- - ---- ------ --- ---- --- - ---------- ------ -- - 1 --------------------------------------------------------- ---� ••---- ------------ - " "---------------------------- -----(f------"----------------------- " I hereby certif that I have prepared this app'lica ion and that t work wil a done in accordance with.San Joaquin County ordinances, St a s, a rules a d regulations of a Sa Joa LOCI H h District, (Signe - -- ---- -------- - - - -SSV--- " (1a., it Contractor) i A P r 5 I (Plot plan, showing size of lot, location of systernAin rela ' wells, 66*-ings, &c'., can be placed on reverse side). f t ' FOR DEPARTMENT USE ONLY w ! i APPLICATION ACCEPTED ------------------------------- DATE-- _ ��r �` ?--------- --------E------- f ------- -- - -- REVIEWEDBY----- ----------------------------------"----- -- ------------------------ ------- ------ --"--- ----------- •--- DATE----"------------------------ ----------"-"------"----"---" BUILDINGPERMIT ISSUED-------- ------------------------------"-"- --------------------------------------------------------- DATE-------------------- ----- Alterations and/or recommendations:------ --- -------------------------- ------------- -------------------------------------------------------------------- - -------------------•----------- ------------------------------------------------------- - --------- --------------------------------------- ---- ------------------------------------- ------------------------------------- ------------------I-------- "-"- ------------ --- -- - ------------------------------------------ ----------- ------------------------------------- ---------------------------------------------------- I FINAL INSPECTION BY:. ----"-"--Gf/ -' Date----------------- - - -----r,.......f�......... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press