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N PERMIT Permit No. -----7517 APPLICATION FO,_ ANITATIO � (Complete in Duplicate) Date Issued --- �iApplication 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. r - 5 JOB ADDRESS A - JOC'ATION------ -� --n1R.r ------------------------------ --R---- - -..-,.- -- Fhone ------- Owner's Name-------- - ----•---\-------------•-----•----------- Address---------- -- Address---------- r ^^ t� f -:`�. � ----------- ------------•-------------------------------------------- = 4 Contractor s Name__.______.;_n_____ / ---------- ----------------------------------------------------- ------ Phone-_ Installation will serve: Residence [9rApartment House ❑ Commercial ❑ Trailer Court ❑ POT 0 [ O3ther ❑ X' f .3 Number of living units: :--!-___ Number of bedrooms -_ Number of baths _--____- Lot size __---i-- __ Water Supply: Public system ©Community system ❑ Private ❑ Depth to Water Table'�F'�_.ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel [-ISandyLoam El Clay Loam ❑ Clay E] Adobe®Hardpan El Previous Application Made: Yes ❑ No g_—`New Construction: Yes plNo ❑ FHA/VA: Yes ❑ 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_______________`Distance from foundation--------------------Material-------------------------------------.._____.___. 1 No. of compartmerits--!--------------------------size-------------------------------..Liquid depth--------------------------Capacity...-------------------- D sl-©sal ,Field: Distance from nearest well,-_______________Distance from foundation_________--__.___-.Distance to nearest lot line.-__________.____ I © Number of lines--- t------------ ------ ------Length of each Line---------------- -Width of trench Type of filter material______________''`_-----Depth of filter 'Material----------------- length_____._______-_.____.________-i F. Seepage Pit: Distance to nearest we11 ' ____ __-Distance from foundation_ _st ___ sta�ce to nearest to ----SN Lining material- '-w aterial_ - = ----Size: MAW'------ __1...........De th- ��------------------•-- Number of pits____-1__ f Cesspool: Distance from neare;`r ell------------------Distance from foundation--------------------Lining material_____________________________._____. Tu ❑ Size: Diameter----------------- ----------Depth----- *--------------------------------------------Liquid Capacity_. •----------------------gals. __.Distance from nearest building Privy: Distance from' nearest well---------- ---------- ❑ Distance to nearest lot li _ //)+A - 'pjp{ [ Remodelin and/or repairing (describe)-------------- - -----_'-_- -- ``t� --• ¢ - ----0 I •c�' ------------ -------------•-- i ....... ---------------- --- ----•---•-------•- -----T------------------------ --------- - - E ---•------ ------ = -------------------------------------------------__------- -------------------------•-------------- ---- n1 - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. .. . Owner and/or Contractor) ��. ----� .---__ � -------------- ------------'- ------- ------ - -------------- - ----------------------- (Signed)-. - - --- ----{ (i t___ _ ____ --------------------------- BY: _______ _ _______________ s l __ .. (Lti Ee ` _ {Title) �`� r BY=----- �- LL� (Plot plan, showing size lot, location of system in relation to webs, buildings, etc., can be placed on reverse fide). FOR,DEPARTMENT,USE ONLY _1 - APPUCATION ACCEPTED BY-------+------- ------------------------------------ DATE � 1'^ ��--------- 1 � DATE----'� -- •-- ----------------------------- REVIEWED BY ---------------------------- r BUILDINGPERMIT ISSUED------------------------------------- -------------------------- -- --------- DATE Alterations and/or recommendations--------------------------- ---- - ------------------------------------------- ---------- ----------------- --- --- ------ -- --------------------------- - - -- --- ------------------------------------------- = ------------ -- - -- - _____j---------- f - --------------•--- --------------- ------------------------------------------ -- &i�� FINAL INSPECTION BY: -- -�--�-- Date =- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 � €S-9-2M , Revised 1.57 F.P.CO.