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_ _ v FOR OFFICE USE: _______ __ ___ APPLICATION FOP, SANTATION PERMIT Permit No. ----------Z-Gl -J---------------------------- (Complete in Duplicate) Date Issued �..":..�..._�� __________-____-__--___________________._-____.___ This Permit Expires 1 Year From 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. JOB ADDRESS AN LOCATION= r�-:' `. � -.. - < _ /. Owner's Nam " Address �� . ....6 �I= ' � - _� ------------------------ �/ `-, Contractor's Name Y. ---------•-( `r t '` `- 1 �"� =- .. !'_done- � -- ---- Installation will serve: Res2rice Apartment House ❑ mmercial ❑ Trailer Court ❑ Motel Cher ❑ / q Number of living units: _.l-_- Number of bedrooms -3— Number of baths ---/--- Lot size ------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ./K ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ENew Construction: Yes ❑ No FHA/VA: Yes E] No)] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.s7_wer is available within 200 feet.) Septi Tank: t nearest welllIfDDistance from foundation-----/_3------ �aterial--..� Noof compartments - Liquid depth�.-.-.-... ... _ Capacity 2,,-E_' J-----Q11, Disp 'sal Field: Distance from Weare t ell_/`,�_ �- ._Distance from founda ion._y? Dish to nearest lot 'ne__ ----- Number of lines________--------------------- ----Length of each line- ,-tet?_'- �'._' ':'�Vi�f(i of trench._.�_. ._..._-----____.-_.._-. i h Type of filter ma terial_:�.._T2_r'-� .Qepth of filter material------- .....- _.Total length-_ _-_ __ ..� --- ----- Seepage Pit: Distance to nearest well------.---------------Distance from foundation--------------------Distance to nearest to line----------------- 1-1 Number of pits________________._Lining material-----------------------Size: Diameter---------....---- -----Depth____________-.-.___.._____- Cesspool: Distance from nearest well-----------------Distance from foundation_-_----- ----------Lining material__.________-------.___.___.._.-.-. ❑ Size: Diameter------------------ ------------------.Depth--------- --------------------------------- --------Liquid Capacity------------------------------gals . Privy: Distance from nearest well------._..--------------------------------------Distance from nearest building_-... ----------------------------------- FlDistance to nearest lot line----------- ----------------------------------------------------------------------------------------------------- -------------------------- Remodeling and/or repairing (describe):------------ � - -!----_l-- -t---1_�--' -(�._� ---------------------------- ------------------------------------------------------------------------------- - � -- --------- ---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this applipation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru sand X�gulan /the San Joaquin Local Health District. _-__.Owner and/or Contractor (Signed)-----------'-- -----=- - -- ------------------------------------------------- ( / ) By:------------------------------------------------- ------------------------------------------------------------(Title)---------------- ----- ------------------__- ------------- (Plot plan, showing size of lot, locationrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------- ----------------------------------------------------------j---_--- DSATE----------------------------------------------------------- REVIEWEDBY-------------------------------------------------- ------------ 4_6 BUILDING PERMIT ISSUED---------------------------- ----- / / DATE-------------------- Alterations and/or recommendations--------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- --------------..---------- C ---------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ---------------------------------------------------------------- tet -------------------------------------- / ` FINAL INSPECTION BY:.__-_-.._ _- - Date....-__._...1 _ + l - - ----------- ---- ---------- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.