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� 7 � APPLICATION FOI. PERMIT Permit No. __7 --- /1� (Complete in Duplicate) Date Issued TA plica a }ion is hereby made to the San Joaquin Local Health Dist ict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. JOB ADDRESS AND° OCATION_... 1 T_ -- --- ---- 1 Owner's Na ��._ ' d "a.�� .��-`------"`---- -- --- --- 1------------ ---- --------- ------- s Conte cfior`s Name ' --- ---------- ---------------- ---- -- ---- - Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _\Number of bedrooms _i4n_ Number of baths __/___ Lot size _� -4>7 '---------------------- Number of living units: Water Supply: Public system Community system [I Private Private Depth to Water Table��t. de fh�bf 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay C] Adobe Hardpan [ICharacter of soil to a p Previous Application Made:- Yes ❑ NoJ><_`New Construction: Yes_( '- No L]TYPE OF INSTALLATION AND SPECIFICATIONS: 11 (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) $eptic.Ta :� Distance from nearest well__,---------------Distance from foundation--------------------Material______-_____-__-----__- _________-______---____- Ar /�� No. of compartments Size----------------------- -------Liquid depth------------------- Capacityisposal F ! Distance from nearest well----------_______Distance from foundation________________.Distance to nearest lot line__..___________._ Number of lines----------------- ---------------'--Length of each line-----------------------------Width of trench----------------------------------- Type of filter material----- -------Depth of filter material------------------ ----Total length------------------------------------------ '1 /(� i 7 Scapa a Pit: Distance to nearest ell_ "_____Distance m Vation___ f __. Distance to near n Number of pits--- __-__.----Lining materia _t- ` Size: Diameter-_�'---------------D< ptn...�1-- _ _ ------ 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-----------------------•------------------ _ - .v, ❑ Distance to nearest lot•'iine----- - =--------------------- Remodeling and/or repairing (describe):_ - - - --------- � 1-- � -----------------------------•------- V / l ---------- ----------•------ ------ --------•--•----------------------------------------- - z; , -------------------------------- --------------------------------------------- ---•_----------------------- --- ----------- --- -- -- - -- 1 herebycertifthat,) have prepared this application and that the work will be done in accordance with San Joaquin um Coun ty ordinances, a laws and rules and regulations of the San Joaquin Local Health District. r , -------------------w 'caner and/or Contractor) (Signed)-••- _ - , �-----------------�--------'-- - --�--- ------{Title)------�-- Y� f : ---------------------------- -------------- (Plot plan, showing siz of lot, location of system in relation to wells, buildings,"etc., can be pla on rg rse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �� ---------------------------- DA --- REVIEWED BY-------------------------------------------��—�-- --------------------- DATE---------------- ---J---- ---------------------------- --------------------------------------- DATE--------------------------- -- . BUILDING PERMIT IS5UEQ__________.-•---_---- ---------- -----�---- Alterations and/or recommendations:________________ _________ --- --- _ ------------- --------- -- ----- ----•---•-- --------------- ••----------- f ---_ _________________________ t __-.-.-._____.___,_ ___________________________ t _ -_____.,__----___-_ --------- ---- --------r----------•------ __--_--.._..-_-_____--__-___- ___----_---__-_____-_--_ ____-___--- --..___-_-._---____.__________-_.-.-______._ _ _ " - Date-------- -- 1ho ----------------------------- FINAL INSPECTION BY:------------- �•y�_.- .--- = N j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATw000 iz-sa