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FOR OFFICE USE: �2 " 3� G� 1.1� ---- APPLICATION FOW$ANTATION PERMIT Permit No. .f2._.. /D-- - � ---------------1:0�-------------- Date Issued -- � ----------------------------_----_ --- ---- ------- ------ (Complete This Permit Expires 1 Year From.(Complete in Duplicate)Date Issued -------- ___ _____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County O'rrdiJr�y�"'rice N 549. JOB ADDRESS AND L CATION__. --------- Phone------------------------------------ Owner's --- ---- ---•-------••------ ------ ------- --=----- --------- ------ - _.---- d Address '�--_1�C----- -- ---- -- h ' --------•---------•----- ------. Phone.. Contractor's Name_______ ----------- - Installation will serve: Residence �partmen# House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___2+-- ber of bedrooms ___I._ Number of baths -� Lot size _7:___..- Private Depth to Water Tabler3-Water' Supply:Supply: Public system Community system ❑ ❑ p § Gravel San Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 fees: Sand ❑ ❑�y FHA/VA: Yes ❑ No pP date- I No New Construction: Yes No .(] Previous Application Made: (if yes, - 4 - f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank cesspool R'rmitted if public sewer is available within 200 feet.) Septic Distance from nearest well____-"'^"------Distance from foundation__�.LL______-.__.Mater�aL___-_.__�'�'_'------------ -------- - r ,. r_ ---T-_ _Li uid d` th-----1` Capauty__ Q!C ='�=�'- No. of compartments-.,.----- - ---------------Size----- -- - q p �` Disposal Field:`; Distance from nearest well-==.-_.__Distance from foundation_ZO_____________Distance to nearest lot line__4r-.____ Number of lines-,---2 - _ Length of each line__..-�.C�-----------------Width of trenc -------- .-- ..............`... Total length of filter material _— jj ---- Depth of filter maternal_�_�_-__----------- 9 �- , 00 1 [a`.__.___.Distance to nearest lot line-__--.... Seepage it: Distance to nearest well___________________--Distance from foundation 0 /_ ��_F+. Dept h-------c2i_ Number of pits-`__Q-----------Lining materlaC�--P �. Size: Diameter. ! Cesspool: "` Distance from nearest well_________________Distance from foundation_._._.--.______°--:.Lining materia___.__._.__-___._----- --als. � Depth----------------------------------------------------Liquid Capacity-------- g Size: Diameter-_�---------------------- ------- - � � El Size: Distance from nearest building------------------------------------ Priv Distance from nearest well._.----____----____._- y: ------------------------------------------- G ❑ Distance to nearest'lot line--'--- ------------------------=- ---------- ----------------- tF ______________________________________________________________________ % I Remodeling and/or repairing (describe):--------------------------------- ---------------------------------------------- ------: �! ' ----------------- ----------- -•-------------------- --- -------------------- r ---------------- I --------- ------------------------------------------------------------------ ,. I ------------------------------------------------------------------------------------------------------ - = - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County j ordinances. State'laws d rules and re ula ions of th an Joaquin Local Health District. f --- ----------- _...(Owner and/or Contractor) # _ ___________________________________________ _ -_______ (Signed)_ --------- ---------------------------------------------------- t:__ --------------------------- --------- ------ BY:--------------------------------------------•-------------------------------- ( (Title)- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I' /�jVJ�•Fl5 -- ------------------- - ---------- ----- DATE---_�L------------ APPLICATION ACCEPTED BY___a�r-- .. -- -- -------- ------ - REVIEWED BY-------------`----------- --------------- ------------------------ DATE------------------------------------------------------ BUILDING PERMIT ISSUED---------------------- 1.4214 ----- G Alterations and/or recommendations:__..I ------- ---•----------------------------------- ---------------- -.---•------------------- ------ - --- ------•- ------------------------------------------------------------ --------------------------- --------- ______ ____________ i ----------- .. -f____________________ -------- 10116 -- Date------- -----1—-------------- FINAL INSPECTION BY. ----- --------------------..- t SAN JOAQUIN LOCAL HEALTH DISTRICT i € 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California Tracy,California 4 F.P•CO•