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FOR OFFICE USE: <br /> -� -�-�--- ----------------�-'...D. ` <br /> ------------------_..-.--.._-------_ ------------------ APPLICATION F611,SANJTATION PERMIT Permit No. A(_-4� <br /> ----------------------------------- -------------------- (Complete in Duplicate) 7 <br /> ---------------- This permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordina No. 549. <br /> , <br /> JOB ADDRESS AND LOCATION-_.- --_- •- <br /> Owner's Name- '__1 ---------- --- ----------------------------------- - <br /> ------------------------ ------- -- Phone------------------------------------ <br /> --- - <br /> Address_._'_1_ <br /> i --------- l <br /> Contractor's Name - ------------ Phone- lP - 7� <br /> Installation will serve: -Residence [4-"�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- - Number of bedrooms ___`- Number of baths --l_-- Lot size __ -� �Z _._----------------- <br /> Water Supply:. Public system Community system ❑ Private 0 Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel'❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑- Adobe 0-'14ardpan ❑ <br /> Previous Application Made: [If yes,date_-.- -------------) No gj-"'New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> e .c <br /> (No septic tank <br /> from k sl permitted <br /> well def public sewer is available within'20D feet. (W_� <br /> ------Distance from foundation------------------- Material------------- <br /> ---------------_-------------------. <br /> Noof compartments--------------------------Size----- ------------------•-- Liquid depth-------------------------.Capacity------------------- O <br /> 03 Distance from nearest well_________________Distance from foundation.-_.... ------------Distance to nearest lot line----------------- <br /> Number of lines------------- _ ..--_---Length of each line--------------.--_----- ....Width of french---_---.-.---_-__ <br /> ----------------- <br /> Type of filter material--------------------------Depth of filter .material------------- :,-.-Total length--------------------.-_-----------------.- <br /> 4 Seepage Pit Distance to nearest weliY _Distance o foundation---_Z/ _---. istar��e to nearest lot line- --> '�'*' <br /> Number of pits----- -------------Lining material--- 't~1r-Size: Diameter._- , <br /> Depth_-. . - <br /> Cesspool: Distance from nearest well-------------_--Distance from foundation---------_-------..Lining material-------------------------------------- <br /> 0 Size: Diameter- -------------------------- --------Depth------------•------------- - - -- ------------------Liquid Capacity -------------gals. <br /> Privy: Distance from nearest well---------- <br /> -----------------------------__._--. Distance from nearest building....---------------------------------_---. <br /> ❑ Distance to nearest lot line <br /> ----------------- <br /> Remodeling and/or repairing (describe):----- ------x- ------------------------------_--------------------------••-- <br /> ------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----- <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, to law , and rules nd r ulations of the n Joaquin Local Health District. <br /> (Signed) ----------- (O er and/or Contractor) <br /> BY- ----------- ----- --- / - p ------------{Title) <br /> ------------ <br /> (Plot plan, showing size of lot, location of system in relation to s, buildings, etc., can be plced on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> ----------------------- <br /> APPLICATION ACCEPTED BY------------------ �. �-__________ <br /> ---------------------------- DATE----------�--- 7 _--------------- <br /> REVIEWEDBY-------------------------------------- ------ ------------------------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED------------------------------- ----------------------------------------------------- ---------------- DATE <br /> Alterations and/or recommendations:------ -------------------------- --- ------ ---------------------------------- - <br /> --------------------------------------- ----•---------------------_ ----- -------------------------------------------------------------------. ----------•-------•------------------------------------------------ <br /> ---------------- -----------•----- - --- •-------------------------------------------------------------- ------- ---------------------------------- ------------------ ------- -------------------- ---- <br /> "F <br /> ----------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.-t ^.` -' -_-1_-- -- �--�----- �S <br /> - �---------------- Date-- ------------------ ------------------­------- --------.---------- f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:eiton Ave, k. 300 West 0 street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />