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FOR OFFICE USE: Permit..No. -._ ..... ---------- -- �v 7,1 S�>�8' APPLICATION FOR 5ATIITAYION PERMIT - (Complete-in Duplicate) �/ bate Issued ,/_-_-___ ... _---------------_.__ .___._---- -_- This Permit Expires 1 Year From Date Issued I 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 Ordinance No. 549. ---------------------- JOB ADDRESS AND LOCATION------- �. }` 1 ----------------- ---- ---- ------ Owner's Name t Phone -•------------•-- - ------ - ------ rp_!____________________________________________________ Address------------ --------- ._.. J�- ------ ----- Contractor's Name--- -------- --- ---- - + -------------------- Phone HousCommercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment ❑ ❑ / Number of living units: _ __ Number of bedrooms _r Number of baths-P-2.-_ Lot size ___AF' � -/---� --------- 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 ardpan ❑ Previous Application Made: (If yes,date.... } No New Construction: Yes ' No E] FHA/VA: Yes J-] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ ______Distance from found _._ ation_ -------Mater�l _____ _ -.-_ . __ -.-_. No. of compartments------r�. ----- Size Q_ -5�k_4r Liquid depCapacity/0:---- Capacity � Disposal Field: Distance from nearest well- 0�_Distance from foundation_-/ - _-_Distance to nearest lot line__ _._. O ( Number of lines _ Length of each line__.__ r_...._-___.Width of trench----- '� e Type of filter material-__ -, Depth of filter material__,- -Total length___- ___________________ Seepage Pit: Distance to nearest well.........------------Distance from foundation--------------------Distance to nearest lot line__-_______-_.--._ \ ❑ Number of pits--- ------------------Lining material-----------_-------- Size: Diameter-- --------------------Depth---------------------------------- Cesspool: --------- ------ Cesspool: Distance from nearest well ________________Distance from foundation.---------------- -.Lining material--_.----- _____--__-_-_..-.-_.-_.. ❑ Size: Diameter- ------------- ----------------Depth-------------- ------------------ ----------------Liquid Capacity-----------•--------- -----gals, Privy: Distance from nearest well--------------------------.-___--.---------------Distance from nearest building---------- -------------:------------- -- Distanceto nearest lot line -------------_-------=- - ---------- ---- ----------•------------ -------- ------------------------------------------------- Remodeling and/or repairing {describe):----- - ------------ --------------------------------------------------------------- ----------------------------------------------- ------ ------------------------- --------------- ------------------------------------------------------------- F --------------------------- -------------------------------------------------------------------------- -- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. - A�to ----------------- --.-----(Owner and/or Contractor) B <t (Title)-. ..-............... (Plot plan, showing size of lot, cation of sy min re tion s, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY --- IV , APPLICATION ACCEPTED BY._ __- .- -_ . __-- --------------------- - BATE t"` �D - REVIEWEDBY--------------------- ------------------ -------------------------- DATE IBUILDING PERMIT ISSUED-------- -- ------ ------------------------- ------- -- ------------ DATE- --------------------------------------------------------- ` Alterations and/or recommendations------------------------------------- -- --------------------- ------------------- ---------------------------------•- ------------------------------ ------------------------------------------ --------------- --------------------------------------- - - _ ------------- --------------------- ----==------------------ -------- ------------ ------------------- -- ------- ------ ---- - ---------- - I ---------------------------------- -•--------- ---------------- - ---------------------------------------------- ------------ - - ----------------- ------------------- ----------- --- ---- --- -M ----------------------------- FINAL INSPECTION BY:. - Date. 1. _. `r .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Ha:etton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California I E.H.9 2M 1-67 Vanguard Press