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�OR OFFICE USE: 2.Y3 0 11� b7 ---------------------5��30 - --_„----- ------ --- ----------------- .` --., APPLICATION FOR aANMATION PERMIT Permit No. 1J -- ----------------- ------ (Complete-in Duplicate) -II------------------ .......... This Permit Expires 1 Year From Date Issued Date Issued ----�_"__-�� 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 Count Ordi nce No. 549. JOB ADDRESS AND LOCAT N----�d�--- - ------ . -R` LL - ----- --- ----------------- ---------------------------------------------------------------------------------- ---------- k � Owner's Name-44�sF'`� ��1i u C�-- --------------- Address ---. Phone ------- ---------- Address---------- G�J�- --__-----_ ---------------------------------------------------------•-------•-------------------••-•------------------------ Contractor's Name----- � ----------------- Phone------....-.----•-----_-._-- - ----------------------------------- ------- Installation will serve: Residence elApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _fj--- Number of bedrooms ---Z Number of baths----L Lot size __ _______ ____ ----------__ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _60 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........ I No [ New Construction: Yes ❑ No Er FHA/VA: Yes ❑ No O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se�Tank:, Distance from nearest wall-----_......._---Distance from foundation-----------------_ Material ---------------- _-_____------____-__-. No. of compartments-------------------------Size------•-------------- -----------Liquid depth--------- ------ --------Capacity-•-------------1 ` Disposal Field: Distance from nearest well-_`.......Distance from foundation_/Q_____________Distance to nearest lot line_-------- [ � Number of lines _____if----.-.---._-_ ---_ ---Length of each line__._FD--�_______________Width of trench-- C__�� , --------------- Type of filter material_ ...........Depth of filter material __/8-- g `--------Total length ----------------------- ( -----------------•---- 1 Seepage Pit: Distance to nearest well----___� .........Distance f om foundation__LD__._.___.Distance to nearest lot line.. ....... Number of pits-_- _J---"---------Lining material--%- OC '_--- Size: Diameter-_-_33----------Depth--_A2. -------------------- 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--------------._____-_______---___---__-. ❑ Distance to nearest lot line--------------------- ---------------------------------------------------------------------------------------------------- ` Remodeling and/or repairing (describe):-- ------ ---------- - - - ----- ----- -----------------------------------------------------•--- ------- ------------------ ------------•----•-----•:------------------------------------••------- -------------------------------------------------------------------------------------------------------------------------------- ------- ----------- I - ---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ I hereby certify that I have prepay pd this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a egul tions of he San Ja quin Local Health District. (Signed)---- =----------------------------- ------(Owner and/or Contractor) „ By:_-------------------------------- ----------------(Title)------ ---------- •------- -------------- ------------ -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - --r-- ---------- ---------------- ------------------ ---- - =-------- DATE--------- _./Q G% '• REVIEWED BY-------- ---------------- ------------=------ -------------------- ------ ATE---------------- , ------------- ----------------- I BUILDING PERMIT ISSUED-------- - -- ---- --- - - ATE--------------------------------------------- ---------- ---- Alteration's and/or recommendations:.-_ p / � - - ---- -��-7------ --- -- ------------- ---------------------------------------- - -- ---- ---------------------------- FINAL INSPECTION BY:....... s_ ------------ Date-....,_ - --- ------------------------------------------ SAN --- ------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton Ave. 300 West Oak Street" ( 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press _