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FOR OFFICE USE: / <br /> - - -- - -- - - - - - - . .PPLICATION F R ITATION P. MIT <br /> Permit No. <br /> II - (Complete-in Duplicate) Date Issued -,P <br /> I <br /> ---- <br /> � ,�:-� __ _--__ _-• This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance-�h- �/nom;✓�n��No. 549. <br /> ��,� ���-- -------•-- <br /> JOB ADDRESS A LOCATIO �-� � <br /> - Pone-- ------- -- - <br /> Owner's Name -.Address-_ � <br /> Phone------ ------------------- <br /> Contractor s Name..... <br /> Installation will serve: Residence E] Apartment House F71Commercial F1Trailer Court El Motel ❑ Other <br /> s <br /> Number of living units: __ __ Number of bedrooms -------- Number of baths-------- Lot size ._-- --- -------- -------- ---- <br /> Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z"Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date___-_.------ - ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation________________Material __--__ --- 1a <br /> -- --•- - Size--------- --------- -----------Liquid depth--------- - - Capacity----------------- <br /> ----- <br /> ❑ No. of compartments-- m foundation_../_E1-r.--.--Distance to nearest lot line--t1— <br /> Distance fro -------- <br /> Disposal Field: Distance from nearest well-_/�!? r. r <br /> Width of trench---,�-------------------------- <br /> ❑�- Number of lines -_.____-.__�__----------------Length of each line__ _ ---------------- <br /> _--.Total length_.__ .. <br /> Type of filter material.__ T' Depth of filter material_ / ._" <br /> f' <br /> Sss,t,���'• Distance to nearest well I+P_�J f---Distance from foundation daC-.---- .Distance to nearest lot line-s--- ------ <br /> Number of pits.------ Linin material----�.1 - -. -- Size: r - .-A __.Depth----/`° --------------------- <br /> ❑ — _---Lining g <br /> Cesspool: Distance from nearest well ----------------Distance from foundation- --_--- ------- -.Lining material_________________________----___.--- <br /> Li Liquid Capacity gals. <br /> ❑ Size: Diameter- - ------ - -- Depth--------------- - - - - -- ------ q P Y- ---------- --- --------- <br /> Privy: <br /> Distance from nearest well._---- ----------- ------------------ ----- --Distance from nearest building---------------------------------.--.----. <br /> ❑ Distance to nearest lot line -------- - -- - -- - --------------------------------------- ------- <br /> Remodeling and/or repairi (describ )--------- -- y -------- ----- <br /> --------------------- --- <br /> -- -- ------- - <br /> ry <br /> --------------------------- ------------------------------------------- <br /> - - ------- -- - ---- -------------------------------------------------------------------------------------------------------------------------------------------I----------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la s, nd rules and re ulat' s of the San Joaquin Local Health District. <br /> ti <br /> ____-_---�(SDwxter and/or Contractor) <br /> (Signed)-- <br /> �, - -_ -- --- - • ------------ - - <br /> i pct _ - (Title)----- ------ ------ ---- - ------- <br /> ------ - ----- <br /> (Plot plan, showing size of lot, location of syste in relatio to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ ;7 ,� z'1 --- <br /> ------- <br /> - DATE ------ ----- <br /> REVIEWEDBY ------ -------------------------------- - - ------------------------ --------------------------------------- ----- DATE------- ----------------------------------------- <br /> BUILDINGPERMIT ISSUED........ .. -----.._.___.____.---------------- ---------------------- ----------------------- DATE.-------------------------------- ----------------- ---- <br /> Alterations and/or recommendations:-..---------.__. -------------. --- --- <br /> ------------------ ---- - -- -- -- ----- ---- --- --- -- ------ -- ---- <br /> FINAL INSPECTION BY:," r -__ _4_.`_`- -------- --------- <br /> Date_CC -- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />