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_t FOR OFFI EE .� ----------------- - --- APPLICATION FC f'NITATION PERMIT Permit No. .......... ... --- (Complete in Duplicate) -_.\ �----- This Permit Expires 1 Year front Date Issued Date Issued ________________ __ Application 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. JOBADDRESS ANBgD',L--OCATION---- '.)-/. {'O.:...G- ------- --------------•-----------'---------------- -------------------------•--------------------------------------- Owner's Name_.__�t"tl !Ml lea - Phone-__y�s3f Address ' I --------------------------------------------------------------------- ---------------------------•-----.- Contractor's Name ------... Phone............................. Installation will serve: Residence [!r""Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ `_°� Number of living units: _ Number of bedrooms _�/--- Number of baths �__ Lot size ---_ -------------------` ------- Water Supply: Public system (�' Community system ❑ Private ❑ Depth to Water Table �D_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_ ?--__-Distance from foundation__/d._ -•------ Material---�G---G(----------- - - No. of compartments_____ ___Size....31Y5)(9----------Liquid depth_-..f...._-__----_----__Capacity......'P J.-:_ '� Disposal Field: Distance from nearest well------ ------._Distance from foundation-..0._......-_-Distance to nearest lot lineA$7..`__..... ' Number of lines__/0._`_______________----------Length of each line_I�_`''__?-7�Width of trench._�`�f'_~.__.__________-_.-.- f Type of filter material_�_C.�.----------Depth of filter material __/$.'-----______Total length.._.710....... ____________________ Seepage Pit: Distance to nearest well___- ------------Distance from f undation__,?..a _..Distance to nearest lot line--- :.._....._ ( Number of pits......4------_------Lining material__'_ .0C- ___..Size: Diameter------ : .-.--.Depth__-i;�..___--__--_---- Cesspool: Distance from nearest well---_____---------Distance from foundation--------------------Lining material--------------------__________--___-. ❑ Size: Diameter------------------------------------Depth-----------------•--------------------------------Liquid apacitY....... ----------------gals. Privy: Distance from nearest well---------______-------_------------_-------------Distance from nearest building.--------_______._._.___-------.--:_----_. ❑ Distance to nearest lot line--------------------------------------------------------•----------- -----------•------ -•---=------------- ------- Remodelingand/or repairing (describe):--------------------------------------...................--............-----....----......-.........------------.....-...-..............---------........ -------•-•------------------'•---------------------------------•-------------------------------------•---------------........-.........---------------.........---------------------------------------q-- y I hereby certify that I have pre red this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules ar re lations of the San Joaquin Local Health District. ... - Owner and/or Contractor (Signed)------------------------------------------- -- ( � ) BY� ----- ---------------------- --------------------- ----------(Title)---- ------- ------ --- --- -- - --------- (Plot plan, showing size ot, o ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- n .c' "`'---------------------------------------------_- DATE------le��-"��"....----- ------ REVIEWEDBY------------------------------------------ ----------------------------- -------------- --------------------------- DATE---------------------- --------------------------------- BUILDINGPERMIT ISSUED------ ----•--- -------------------- -------------------- - DATE_................ -------------------;----------- Alterations and or, ecommendationt:....... ........ ......� 4�._ ____ - r�G?o�. -----�"-E'-_-_--� `�'-�----�--''---�'_----- ------•-----------------------'................................................... ......----------------------........----------_..............--...............------•--------•-'------------r..........-•------------ ------------'------------------•---.-_-_....-_-.-_-.-----'-------.--_------_--------------•------ .......-•----------'•-----------_._.................-----------------------------------•-------_-•----------- -------- -------------------- _____......'------------------------------__'-•---•_....... ------------------- _.-------------------- '-------- FINAL INSPECTION BY:-- ----- --- - Date.... . - ------- ------------------ ------ SAN J QUIN L AL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West ak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.P.CO.