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FOR OFFICE USE- -----------------------------------------F----- /! ----------------------------------- ------- ------------- APPLICATION I•GA'§: 4NITATION PERMIT Permit No. .. ..... .- = (Complete in Duplicate) o ,..--, Date.Issued --- --- ------------------------- This Permit Expires 1'Year From Date Issued r 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 o 1' ce.awith County Ordinance No. 549. y27�frs -' ,� t [P�_ JOB ADDRESS AND LO 10 ----------- L Owner's Name N Lr/_.E. L-�--Q i ------------------------------=------ Phone r Address ---( �- - �--------toms ---- -!ii�C_.gp!�------------------------------------------------------------------------------- f Contractor's Name--- VINZ_'-------------------------------------------------- ----------------------------------------------r----- ---- Phone----------- _------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .-... Number of bedrooms Number of baths j__-_ Lot size ----------------------- 14 Water Supply. Public system ❑ Community system ❑' Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam 8-<lay Loam ❑ Clay ❑ dobe ❑ Hardpan tt Previous Application Made: (If yes,date----------------_-- No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: `(No se tic'tank or Less oo{er_mitted'if ublic sewet.is available within 200 (- _ P . P P P Septic T k: Distance from nearest wel :Di- stance from foundation-----'--_--_.--.--.Material-------.__-------------------------------- ---- Septic No. of compartments-- -----------------------Size--------------------------------Liquid depth-------------------------.Capacity------------------ Disposal Field: Distance from nearest well_�w._---Distance from foundation/--------------------Distance to nearest lot line--------------- Number __-_.---.-Number of lines- f-..-..-----_--_--_Length of each line---.----- `_Le-----.Width of trench_..._._.2�./_-------------- d- ApA• Type of filter material..-R .-<----Depth of filter material-.-.--. �---__-._Total length............. ..._......._.___--.- See age Pit: Distance to nearest rwell.-------/�--Distance Wro foundation--- _-10.---.Dista ce to nearest I iine._�?...._.'__. Nui-nber of pits...._..____-._..-.Lining material � --Size: Diameter.3X�---_---Depth_L_Z-----------------`Cesspool: Distance from nearest well-----------------Distance froom foundation-.-.--------------- Lining material-...---..._..-.--.----_-.._-..--...lss. ❑ Size: Diameter---- - -----------------------------.Depth---------------------------------- -----------------Liquid Capacity_---------------------- ga . Privy: Distance from nearest well---------------------------------- ----------Distance from nearest building---__...---------_--.----__-------_-_... ❑ Distance to nearest lot line------------------------- --------------------------------------------- ------------------------------------------------------------------- - \ Remodelingand/or repairing (describe):---------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- -------- --------------------------------------------------•---------------.....----------------------------•-----------------------------------------•---------------------- ---------------•----------------------- .... ---------------- ------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateqla , and rules and regulations of + San Joaquin Local Health District. (Signed)--------------- ------ ------ - --- ------- --------------------------- ---------- --------------------- ---------------------(Owner and/or Contractor) .�� --_---_---------- -- _ . BY� -------- (Plot plan, showing size of lot, location of system in relation to wells, 6uildings, etc., can be placed on reverse side). J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ R-G-------------------------------------------------------------------- DATE-- ----------------- e REVIEWEDBY-------------------------- ----------- -------------------------- ------ ------------------------------------------- DATE------ -------------•-------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-----------------------------"------- --------------------------------------------------------------------------------------------------------------------------- --------------- -------------------------------------- ---------- -------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------- --------- - -------- ------------- ---------- --- ------------- ------- ----- - - l Date. ` "- 7v--------------------------- : FINAL INSPEC -- --- ------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street j� .s Stockton,California Lodi,California �Manteca,California Tracy,California F.R 1:O. �I