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FOR OFFICE USE: o F� 9 7 T" ~ - ..... --------------------------------- in Duplicate) Date Issued ..ate__' -------- (Complete P This Permit Expires 1 Year FromDateIssued �t ; t Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance+ho-:,-549. S7 JOB ADDRESS AND LOCATION_. -I _ 0 r' }:r' if..- ';='a'� ' ----- ----- Phone--'U C?(F-a--------- Owner's Name----� W �r Address-•- -� ----------•-----•--------------•------------••---- - Contractor's Name- Phone----------------------- --- --- - Installation will serve: Residence Apartment House ❑ Commercial ❑lam Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I-----Number of bedrooms - -.-. Number of baths ... Lot size .------ . j-- Water Supply: Public system (�/Communityystem ❑ Private❑ Depth`"to Nater Table«.---- ft.� .m .,,., � t ❑ y ❑ yN © - Y�I] Character of soil to a depth of'3 fee • San ;❑ Gravel Sand Loam Cla �L-oam= Gla. Adobe Hardpan ❑ Previous Application Made/�If yes dater—___,.tom,: --) No NewlConstruction: Yes No ❑ FHA'VA: Yes ❑ No - ...._ TYPE OF INSTALLATIO AND SPECIFICATIONS: e (No septic tank orcesspool �permi#ted if public sewer is availablea within 2d0 fee1. t Se tic Tank: Distance from :nearest well.��1�:�-�Distanc e.from' .foundation.----10.-._------.Materials..." _ ------------------------- Septic ------------ - } i p -----QQ No. of compartment+s=_' 0�- ---- Size----- .gX.S-- iF----------Liquid depth--- ------ Capac�tY i I' Disposal Field: Distan from near s�t'"welL.N+� _..--_Distance from fo ndatio'n'kCt Distance to nearest lot line........------ Number- f lines----- -------------- ----------Length of each linel /lo-�------Width t� trench-----��--------------- J Type of filter mate�ial. _ ----_-__Depth of filter material..."V$--_...----___Total 1 14 lenejth.. .3s�rO--------------------------- 1 f Seepage Pit: Distance to nearest well- ---L*-o" Distance-from foundation..-.-._-----------Distance.to nearest lot line................. Number of p 5- Li9 ning material-----------I---------Size: Diameter...."_-_.:_"_1--- -,' Depth--------- ----------------------- JC El Cesspool: Distance fromr nearest well..__- Distance from foundation.............._..- Lining inateri l--------:...-----------_---- -------- Size: Diameter'#--- -------------------------------Depth-------- ---- ---------------------- --------- 4Liquid apaastY gals. S ❑ Distance from nearest building 'Distance I� --�---- g �f"7 Privy: Distance frominearest well ____________________ ❑ Distance to nearest lot line--------------- --------- t - ---------- Remodeling and/or repa ring (describe);��-o - ----- ----- ----------- ' FK'K--- ------- --------------------- ------------- ---------- -- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and roles and regulations of the San Uoaquin Local Health District. , . (Signed) ----- -- =--_ -.•_ -. (Owner and/or Contractor) - - [Title)--- ---- --------------- ---- --- ------------ Bn }'ho "" ": � t,_ - --- - • - . buildings, etc., can be placed on reverse side). (Plot plan, showing size of lat, location of systn relation to wells, build t FOR DEPARTMENT USEONLY ~ APPLICATION ACCEPTED BY -------------------..DATE �'�= 5_-46--------------- ------------------ ------ ----- - _ REVIEWED BY---- ------------------------- ------------ ------------ ------ --- -------------------------------------------- ------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------- -------------- -------------------- ------------:# -=---"---- DATE---------------------------------__....................-- Alterations and/or recommendations:-------------------- - _-"- -- - --•------------------------------------------------ ------------------------------ FINAL INSPECTION BY:..- - �`1`�`�--"'-------- ------------ Date.....__--- ___-- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi,California Manteca,California Tracy,California