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x v �- \ APPLICATION FOR $"ANII�ATIbNt PERMIT Permit No. ..��...!.:�.. (Complete in Duplicate) Date Issued ... Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance.with County Ordinance No. 549. JOB ADDRESS A LOCATION : � � "'' ----•-..a� 8fs Owner's NameLjl� ------ Phone- -•-- Address---- + %... -- -- -------- ----------- Contractor's Name..........AA--� d-` ---•- ----•--................................ Phone-.*-d .h0, _.. Installation will serve: Residence ®,Apartment House ❑ Commercial ❑ Trailer Court ❑ MothE] Other ❑ Number of living uVits: -/-_ Number of,i eclro8ms- __. Nurnbeq of bat)i3 of size ---_. 1'? Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table s ft. Character of soil to a doh of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam Clay❑ Adobe❑ Hardpan Previous Application Mad+ : Yes ❑ No UKolNew Construction: Yes M-IN"'o ❑ FHA/VA:Yes ❑ No ❑ TYPE OF INSTALLATIO14-.'GNU`SPECIE CATK)tq (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well/.� Distance f;pm foundation_ Material— � No. of compartments______:_--c9 ______--Siie._-�------3.6-'.- q p p---._Li uid de ,th__�_--_ _.....capacity i w '� ... Disposal Field: Distance from neares# well •_Distaoce f,om foundation j;Zo .Distance to nearest lot line Number of lines.-----•%_- ------_-,,-�*�----- ..Laingth of each line........'75'-_.-_._,...Width.of french... Type of filter material._ -r_� -Depth=of filter material-_-_�g''.__...Total' length.''.. _7-Z........... Seepage it: Distance to nearest well-/-5 -.__._.Distance f m fun da tion__.1�...,. . starg to nearest lot lice 147.1 Number of pits___.,�._______ _ kining material-_ �__--Size: Diameter'-"1.0313.1.... Depth_ ... Cesspool: Distance from nearest wells•_.. -_____`-Distance from foundation________ _________Lining material _____.... _ --..._... .._._..... Size: Diameter--------------------- Depth -- •-•---------------------------Liquid Capacity....---------------:7......gals. Privy: Distance from nearest well.. ------------Distance from neatest building________________ ......... ❑ Distance'to nearest lot line------------------ Remodeling -- • ----Remodeling and/or repairing (describe):-- -r------ ------- -- ---- -- -------------------------------------..,.._ .,------------_ ............ r ..................... .._•____._._...-------- •--------------------------------------------------------------------------- ....... _........ ._......_. __.._--: .•_-_-. ...................... � --------------------------------------------------------... ..__.--....._•__...... .....__. ..._..._ ......_.. ..................................... I herebyTceihat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Ss and ryles nd regula ' ns of the San Joaquin Local Health District, (Signed) -- - ---------------------j ------------------------ ------- ------- •------•----(Owner end/or Contractor) By.................................. .�.i-�2 ....(.�f.E� ---------------------------------(Title)----�--= (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side)-- FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY-- -------_. .•..--- ----•---------------- --------------------- ----- ••--•• DATE,1.................. ...................... REVIEWED BY..................... ---- DATE.. -------------------------------- BUILDING - PERMIT ISSUED ..•-•-- ............................................._ -------- %--;----- DATE Alteratins,and/or recommendations._:. --------- . � - ................... .....-- ----- - jCA ------------------•--------------------------- FINAL INSPECTION BY:• . ........-.4................--------- ---- Dater -- .-f-.--... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy,,California ES-9-2M , Revised 1.57 F.P.CO.