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F R O,TFICE USE: 5-------------- ----- 3- J - - '.✓; ' APPLICATION FdR:`�NITATION PERMIT Permit No. = s i (Complete in Duplicate) ___________________ 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 i all thgw r'k eredesgr This application is m e in compliance with County Ordinance No. 549. vl ! JOB ADDRESS ANDLOCATION _, �___ _ Owner's Name lr ve_ Phone-------------------------------•--- . ----------------- -------- - ----------------------------------------------------------------- p Address-- ..../---- -- fi ----- - ---- --------•------ Contractor`s Name----- --- - ------4i ------------------------------- _ Phone-----------..------------ I Installation will serve: Residence Apartment House I]' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ z Number of living units: --/-- Number of bedrooms--- Number of baths A--- 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 Qr-�New Construction: Yes g?"'Ro ❑ FHA/VA: Yes P- 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-AO-7------Distance from foundation_��----- ____.Mate 'al _ __..._-____. p No. of compartments.._og------------------ _Liquid clQe�pth___'V4f --- -----Capacity--ee-4--------- Disposal - --!_. Disposal Field: Distance from nearexf��+'ell_.,.W_--_ Distance from foundation_AP. _____-Distance to nearest lot line_149_______ Number of lines______ �_._.. _.._. __.___ Length of each line_�tz�____. g Width of trench_�_-_-_.�,_-______________-_ Type of filter material _--Depth of filter material--,�--------------- ---_ -. Total length___�ta�7-------------------------- Seepage Pit: Distance to nearest a�well._�B _______Distance fr m fo ndation_____ 4-_.___Distance to nearest lot Number of pits_____A------------Lining material-_ ..Size: Diameter—?S-0.6-........... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- UI ❑ Size: Diameter--- -- ------- --- --- --- -- ----- Depth----------------------------------------------------Liquid Capacity----------------------------gals. VI i Privy: Distance from nearest well-------------__------------------------------ _._-Distance from nearest building__________.________.________ i ❑ Distance to nearest lot line---------------------------------------------------------------------- ------------------------------ 1 ------------------------ Remodeling and/or repairing (describe)--------------A60;v --- ----------------------------------------I------------------------- ---------------1--------- -----------------••--•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- N ----------------------------------------------------------------------------------------------------------- ------------------•-------------------------------------------------------------------------------------- ----- t ------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin',.Coun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Sr ed -- �/or Con�rac+or) By:-------- •--------------•----------------------------------------------- --------------------(Title)----( .�u� --'------------------------ ----------- (Plot plan, showing size of lot, location of system ination to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! .a - APPLICATION ACCEPTED BY ----------------- ------------- DATE -- .�- - REVIEWEDBY-------------------------------------------------------------------------------------------- --------------------------- --Y DATE---------•------------------------------------------------- BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------- Alterations and/or recammenda ions:------------------------ r ` �,1 '' '` /e= -------- - - ------ ------------ - 9 -2 - - - - �.� "i- _.- .� - ------------- _____________ ---....____..._.___.__._..___._...______._...______.___.___-._-.____.------------___-_.----------___._._____..._____._.___________-_...__..-- -._ _ __--_- __________________________________________________________________________________________________________________________________________________________________________________________________________ ______----_---- _ FINAL INSPECTION BY------- ......... ----------------------------------- Date_ -2_7-2,& r — --------;---�-- ---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California k Tracy,California r•.a.co. 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