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FOR OFFICE USE: =l� Permit No. ._2.1�� S� APPLICATION FdR*tANTATION PERMIT (Comple+win Duplicate) 1' - Date Issued This Permit Expires 1 Year From 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 County Ordinance No. 549. _ td4 (' J JOB ADDRESS AND LOCATION �] __- Owner's Name. ---- Phone C� 2 -19/2 ' Address -------- -------------••--------------•-------------•-------------------•------------------------------------------ ---------------•----------- --- ' ;a ° Phone-- z--e--------------- Nares ----- Installation will serve: Residence (� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number ofIlving units: __1---- Number of bedrooms __Z_ Number off,baths _ -____ Lot size ___. - -:-- --� �a---------------------------- Water Supply: Public s1. ystem ® Community system ❑ Private d. Depth to Water Table __.. _ ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 10 Adobe ❑ Hardpan ❑ 1, t Previous Application Made: llf yes,date--.---------------- ) No ® New Construction: Yes ❑ No K FHA/VA: Yes ❑ No f TYPE OF INSTALLATION AND•SPECIFlCATlONS: (No septic tank or cesspool permi#ted.4-public sewer is.Xilable within 200 feet.) Septic Tank: Distance from nearest well ................Distance from foundation------------------- Materia4 --____..________......___._____._._.______--_.. ❑ No. of compartments----------------- ---Size----l------- ------ -------_- Liquid depth Capacity f Disposal Field: Distance from nearest well---/V ----_Distance from foundation---AG_-------.Distance to nearest lot line_--gip_.--.--- Number of lines-------- I----------------------Leng11 th:of each line_.___`-`� -f---------.Width ofgtrench------- �._----- ------ ' ------.Total length v -•------------------ Type�of filter materiai__.gd-Gk------Depth of filter material _ Seepage Pit: Distance to nearest%�_vell___. _4__ ._.t_Di ante,from foundation___&`-----._Distance to nearest lot line--.o---f.-__.._ Number of pits_./_../---------Lin'Mg material _, 8 '.- Size: Dia meter.-.33-..---------Depth.---- ..i ------------- 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...........___-._______._.----_---------. r ❑ Distance to nearest lot line ---------' ----------- ------------------•----------------------------------------------------------------------- --- -- Remodeling and/or repairing Edescribe)--------------------------- -----"'--- ----------- --- Et ------------------------- -•I------•-------------------- -------------.._- ------------•-----------------------------------------------�---------------- ----------------------------- ---------------- ------------- --- ------------------ --- I1 ------------ - - - -- --- - -- - - - _b ------ ------ - - - kI 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. /-`-- -----------------------(Owner and/or Contractor} (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 l APPLICATION ACCEPTED BY._ DATE---- _., ___6- --------------------------- -- REVIEWED BY-------- ------------ - - DATE---------------------------------------------.------------- - -- -------------------------------------------------------------------------------------------- BUILDING PERMIT ISSUED------- - ---- -------- ------------------------------ ----- DATE------------------------- ------------------------ Alterations an�dfor recommendations: _ - -. ----- C-._- i4. Date-------`� ~t` - -------------------•---- ---------------- FINAL INSPECTIO BY:........ -__-- --- ._.---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.K.92M 1-67 Vanguard Press