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r FOR OFFI U I_: t� old � -------VIVA, ----------------------- ------ -------------------------- APPLICATION F_�.,R'Si�NITATION PERMIT Permit No- -_--•--------------. ----------------------- --- ------------------------ (Complete.in Duplicate) Date Issued ------------------------------ ---------------------- This Permit Expires 1 Year From Date Issued Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work.herein descried. This application is made in compliance with Count Ordinance No. 549. /J R� - JOB'ADDRESS AN LOCATIO �`lil 4-- - ---- ----- ! Q Owner's Name-- Y�2 ! _ - -- -- .. Phone___ _6_1570 ---�-111 _...---- ...--- - --- ---- ---/--- - ---- ---- -- -- ------•------------------ ---- �•- ---------- Address.----, _.. t x- -- �! � Contractor's Name-----.. �. ------------------- Phone--------••--•--•--•-----••--------- ...... Installation will serve: Residence Z" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ie Number of living units:'__-I-- Number of bedrooms __ " Number of baths -Z-Lot size'_ _��,;�_Te_,'____________________.______ Water Supply: Public system ❑ Community system. ❑ Private .[B/Depth to Water Table 7Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarcl ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: {If yes,date______ ------------Y No PT" New Construction: Yes Zr-N-o ❑ FHA/VA: Yes Fill"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Y Septic ank: Distance from nearest well--- _-Distancg from foupdation___4/7-------.M terial_ No. of compartments.......�.-----------Size�l�--XSX�---------Liquid depth---'7��,-----------Capacity---.L�+Q .-- Dispos field: Distance from nearest well10C _----_Distance from foundation_.I _ Distance to nearest lot line --------___ [ Number-of lines__------- ----------------------Length of each line____----f ----- -Q---- Width of french. - ------------ s - Type of filter material-_ __D.� _-�e--_Depth of filter material__407 length------------3120-_______________ r Seepage Pit: Distance to nearest well___--------------------Distance from foundation____________________Distance to nearest lot line___-__________._ ❑ Number of pits----------------------Lining material--------------,--------Site: Diameter------------------.----.Depth------------------- Cesspool- ---Cesspool: Distance from nearest well_______________`Distance from foundation---------------------Lining material___-------.--_---__._________________. � ❑ Size: Diameter----------------------------- --------Depth- ------ --------------------------------------------Liquid Capacity- --------------------------gals. r0- Privy: Distance from nearest well---------------- ____________________________Distance from nearest building ❑ Distance to nearest lot line------ ---------------------------------•-------------------------------------------- ------------------- ------------------- I' Remodeling and/or repairing (describe----------------------' ------- - ----- � --- 7 { ------------------------------------------------------------ --- y I hereby certify that I have pre, ed this application and that the work will be done in accordance with San Joaquin County PE ordinances, Sta laws, and rul s-,a e a ons of the San Joaquin Local Health District. (Signed)------------- -- ----------------------------- ------------- ------------------------------ -------- ---------- --- (Owner -------------------------------------------------------- ---------------------------------------------------- Title------------------------------=----- . . ..... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPA ENT USE ONLY APPLICATION ACCEPTED ------ ----- -•---------------= DATE..-7,_J' '- = REVIEWED BY----------- --------------- ------- DATE------- - •- ----- • ------------------------ BUILDINGPERMIT ISSUED-------------- ------------------------------------------- -•- ----- -- DATE------------------------------------------------- ------- -- Alterations and/or recommendations:__.;_____ -"�— ='=-�=;S ------------ --- ----•- ----- -------------'.----c--------- "-! •� C*= -!-_rl' K=` - ----`----=--z`. ` ---------------------------------- - - -------------- -•-------------------------------------------------- ----------------- --------------------------------------- --------------- ----------------------------------------------------------------------------------------------------------------------'-------------------- R.. - - fp,_ G- -tz.`—_ ----- Date---- ---- --------------------------------- FINAL INSPECTION BY:....-'�. - - ----------------- -- � ---- -- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REV1FEa 8.59 3M 3-'63 F.P.CO. � M r