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FOR NITATION PERMIT Permit No. ._ ---- - APPLICATION (Complete in Duplicate) Date Issued __��1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. his application is made in compliance with County Ordinance No. 549. r �f -. JOB ADDRESS AND CATION. ✓ ` f Owner's Name10 -- Phone-. Address___ -- .mac`--'�- --------------- ' --- -- - - Contractor's Name------ -------------------------------------- ----------------------------------------•--------------• Phone i Installation will serve: Residence?Number Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ther ❑ I Number of living units: _-- of bedrooms " �/- Number of baths _ Lot size ---------�4?_ ��------_---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table�-�__47_ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ f Previous Application Made: Yes ❑ No New Construction: Yex No ❑ FHA/VA: Yes ❑ N9-< TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 240 feet.) G --eptic Tank: Distance from nearest well----------------- from foundation--------------------Material----------------"________._______-'---------- . C No. of compartments--------------------------Size--------------------------------Liquid depth---------------------- ---Capacity---------------------- G Disposal F' Id: Distance from nearest well- O'1— _._Distance from found ation �� Distance to nearest Iot�lina�R o /� � Number of lines------------/------------ ___ Length of each line-----_ -_ -- cfi--_.Width oftrench---��--- -------------------- Type of filter material, -_-_ gth_ Depth of filter material____.__ __-_ -7otal len ."__". �________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----................Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material---------------_-------Size: Diameter-------------------__--Depth----------------------------.---- —) Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------_____- ❑ Size: Diameter----------------------------- --------Depth-------- -------------- - ------------------- --------Liquid Capacity------------------ ---------gals. - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------ .__--_-______._. w ❑ Distance to nearest lot line-------------------------- ------ - ---------------------------------- •----------------------- ----------------•--------- ---------------- Remodeling and/or repairin scribe):----- - - s — - --------- ---- --- --------- -- - -- ----- - -- ----- ------------------------------------------ ------------------------ -------------- -------------- ----------------- ------ ------- --- ----- ---- -- --------------------------------------------------------------------------------------------------------------------------------------------------•---------- I hereb certify fhat I have prepared this applica+ion and tha+ +he work will be done in accordance with San Joaquin County ordinances, t laws, nd rules and regulations of the San Joaquin Local Health District. (Signed)------- --- ._ --1--------- ----------.� -- ---= - - - ----{Ow /or Contractor) (Title)- ____ (Owner ------ -•----------- --• - -- ------ --- -- .� --- -------- Plot plan. showing size of lot, location b system ' rc ation to wells, buildings, etc., can be p a ed on re { P 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------ _-.-____-____------------------ DATE_ --_-___ DATE.__ REVIEWED BY---------------------------- ---- "��"�`�"----------------••--------------------------------- --------------------------------------------------------------------------------- BUILDING PERMIT ISSUED ------------ - - TE ------- --- Al+e tions and/or recommen ati ns �� l --�------t------------------------------------- ----------------------------------- ---- ---- - ------------- �a-Yt ! , yam_._..._ __ - -""""h_ -------------- ' f____ ,. . w - ---------= dry• �_f__.___ _____.__..._ _ .____ -_-___-"-_____.____.__.___----_. ._ FINAL INSPECTION BY:.._�.L.r r -- -------------- Date-- ----- ---------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 FRCO.