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/ FOR OFFICE USE: GO- - ---------------- ---' - - -- -- --- ------------- L ----------------------- ------------------- ----- APPLICATION FORANiTATiON PERMIT Permit No. .------.3 3� r -- ----- ------ -- ---------------_--------- (Comple+e•in Duplicate) Q Date Issued This Permit Expires 1 Year From Date Issued -%---=- 47 k Application 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 Ordqi (e No. 549. �/JOB ADDRESS AND O TI ------ - - -- c- .Q - n ;O --/` wner's Name_________ __ �_--- --- ----- -- ----- --------------------- --------------•--------- Phone------ lo�- F6 Address----------------•----------- k Contractor's Nam &4 � " fZ .. J.. . Phone. Installation will serve: Residence [Apartment House ❑ Commercial Ej Trailer Court ❑ Motel 0 Other ❑ Number of living units: -/----- Number of bedroo -- Number of baths I--- Lot size ----- ------ _____________ " Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table - ___ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay-Loam ❑ Clay [] Adobe Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No &—FHA/VA: Yes ❑ No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permitted if_public sewer is available within 200 feet.) is T Distance from nearest well---- .-..---__Distance from foundation-------------------- Material..._._ ------ NO. of compartments------------- ------- ----Size-------------------- Liquid .depth Capacity sposal F Distance from nearest well_'_ Distance from foundation-s-- '7' ��•�- ��.-_..--Distance to nearest lot line---��____-. Number of I-n. .---�____ .__.__--.]�k'...'_bepth Length"of"each line""' -� Width,ofJrench.,Z_V_"-----_.___-_-- Type of filter mataria --- - of filter material...t-9 �--_-.---.Total lengfh--.___61__B--------------------------- Seepage ___________________ __Seepa a Pit: Distance to�rearest well-._�CdNA=rnDistanceAom foundation---�. ----Distance to nearest I line---- -- _---- Number of pi+ _�-�_______________Lining m�ferial__f�fI K i Size: Diameter�j f_.---Depth__. `1___-_________-__---- ! Cesspool: XDistance from nearest well ----------------Distance from foundation----------------- . Lining material-_.-_--------_-_--------__---------- ❑ maize: Diameter- _z --------- ----- ----------------Depth------------- - ---------------------------_ - ---Liquid Capacity----------- -------------- gals. —Priyy: F Distance from nearest well------------------ ------___----------------..._Distance from-nearest building__.------.-------- ------------.-5..--.-- ❑ obistance toft nearest lot line-------- ------- ------------ - ----------------------------- A ----- - ----------'-------------- - --�- �- Remodeling and/or repairing (d��r;be): --- ---- - -- --- ---• -------- ------------------------------------------------- A. ! � ( + �- ----------------------- ------------------------ ---- -------- --. . f ----------------------- ------------------- ------------=-- 4= `` ,!--- - - 1 - --- - - - - ---------------- I hereby certify-fhat I KBve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SfTat !A� and rules,and'regulations of the San Joaqui al-Health District. (Signed - 1 -- u9 wn enrd Contractor) ------------- --- BY=--------------------------------!n-----------------------------------------. -- - ----------- - ------------(Title)------ ......... ------- .-......_...-------- .... " (Plot plan, showing size of,lot, location of system in,relat' to wells, building e.c., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1- — APPLICATION ACCEPTED $ A - - DATE �� f� ." `�------------------- - - REVIEWEDBY-------------------------- ----------------------------------------- - --- -------- --------- -------- ----------------------- DATE------. BUILDING PERMIT ISSUED__-Z--'-- ------------------------------------------------------------------------- ---------------- DATE--- --------------------- ---------------------------------- Alterations and/or recommendations:--. - - -------------------------- ------ - ---- -------------------------------- ----------- ----•-------------------- •--------- --------•------------- ,_ --------------------------------------------------------- ---------------------------- --• ^- ---------------------------- ----•-------------------- ---------------------- ----------- -- ------------------- ---------------- .. . . - - . ,w.•.r FINAL INSPECTION BY: .-�`y '� °.. f�� Date---`_ Z SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press