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FOR OFFICE USE: r -------------- ----------------------------------- -- ------------------------------ + .. ` ____-_- APPLICATION"I dk'' ANITATION PERMIT Permit No. ------------- -- / ----- ------------------------------------------._4 = (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 install thework herein describe . This application is made in compliance with County.Ordinance No. 549. ��0 JOB ADDRESS AND LOCATIONE CAL04_- -1 EL �� OF �� j �` { , ------------------------- Owner's Name---_------1�V-AYY&�----- ----------------------____ Address------ �-----•-F,T �� -F Cn 4-ON -----------------------------------.�-€-------- ---------------------•------------------------ Contractor's Name-_-__QStI,lNaK I_A. #.---- ---------------------------- -- ----- 1 __----- Phone------------------•-•-------------- Installation will serve: Residence A artment House Commercial p ❑ ❑ Trailer Court Motel ❑ Other ❑ Number of.living units:..--_ ___ Number of;bedrooms _2—Number of baths -------- Lot size"-- I( ___ �•___ Water SuppI • Publics stem Community ys�tern r[�K, Private ❑ Depth to Water Tae F-3v ff. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam Giay ❑ Adobe ❑ Hardpan { . Previous Application Made: (If yes,date ) No New Construction: Yes No FHA VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ,,, ; _- •" (No septic tank or cesspool permitted if public sewer is available wifhin-200 feet.) J Septic Tank: Distance from nearest well_________________Distance from foundation------------- ____.M'aterial_---_-#____-.--________--_._______-._____-_--_. E�Tl N1C No. of compartments-------------•-----------Size_:___-------a--------- - - ---,--_---Liquid depf h-�---- � ------- ---Capaci#Y------- ------- --• --• �'� i STI Alia- Number of lines_____._,__ ___ stance from #oundation..-__ _Distance to nearest lot line__________... F ! /.- - S H Disposal Field: Distance from nearest well-lh�-- -Length of each line-__-____. ____-______ .W.Idth of trench ____ _ _______________..- ; - - " p g �,�[7 -r- filter material -_ C+-- --- -To a'I length---------0 ----------------------- Seepage ------ ' th =+ ee- a ePit: D+tanocef toenear nearest material -__�� D stance from foundation---:__I0.___-Dist nce to nearest lot ine--__;�_�-___ � p Number of pits------I___-________Lining material__130-O''_.__.Size: ,Diameter--�.X,,,,��_�C,----Depth------6-� Cesspool: Distance from nearest well------------------ from foundation-tv� ---------- .. "___ Lining materia L____________ f____-__-___. S ❑ Size: Diameter-------= -_ ------------- -----Depth---------------------------------=---------------Liquid Capacity------------------------ - gals. Privy: Distance from nearest well------- -------------------------- --------__Distance from nearest.building__-_________--_-______-____-____--_-_--. ❑ Distance to nearest lot line----............................=77-777---------------------I---------------------I------------------------I----------------------- Remodeling ---- ------ --------------------•-----------------------I--------------------- Remodeling and/or repairing (describe):---------- 3 ittt -"A. ��t r�----------- ! --•------------------------------------ ------•------------------- ------•----------------------------------------- it ' ' --=---- ----- ------------•------- --------------------------------------------- A ---------------------------------------------------------m------------------------i-------------------------------------------------------------------------------------------- __________________________________________________s____________--_--_________--__-___-______--_--_-______--___-_________--_________________-_-_______-______-.--___-______--__-_-___-____..__-----______--__----------_---- I hereby certify that I have prepared this a p ication and fhaf the work willa done-in actor ante with San Joaquin County ordinances, State laws, and rules and regu .ti s of the San Joaquin Local Health District. Y _. - _ - .,-----: (.. .caner and/or ontract� or),._, By: --- --------------------------------------------------- -- ------ ----- ------(Tiifle) ------------ : (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ,- -- --------------------------------------------------------------------- DATE------- I_ REVIEWEDBY--------------------------------------------- -------------------------------------•- -------------------------------- ----- DATE---------- -------- BUILDING PERMIT ISSUED----------------- ----------------------------------------•------------ -------------------------- DATE-------- ------ Alterations and/or recommendations: ------------------ --- ------------------------------------------------------------------------•----------------•-------------- ----------------------------------------- ----------------- _ = - - - --------•---•----------•-----------•----------------- -----------------------------------• --- - - _. ---------------------------- -------------------'-------------------------- - ----- -------- _ �' + h� .�r n f'�n`� __...-•-------- -i --------•------------- - FIIJAL INSP- i --- - - Date / ------------- !-4 SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 F.Na=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California R Manteca,California Tracy,California I ES 9 REVISED 6-59 3M 3-163 F.P-Ca. ` f