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FOR OFFICE USE: APPLICATION FORZANITATION PERMIT Permit No. (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 Count Ordinance No. 549. � e JOB ADDRESS AN LOCATION-- -c - d - ±�� ------- --- •------------ 0 Ll !�f Phone---------------------- .. Owner s Name----- --------_------ 7 __ ._---- -- ----------------------------------------- Address----------•------- --------- ------- __7---- --��- ---�1 .a_' - ---_-----r-/ Contractor's Namedj1Phone - ---------•------------- Installation will serve: Residence Apartment House EL Commercial ❑ Trailer Court ❑ Mo ❑� Other ❑ 1 --- s ----- Number of living units: I------ Number of bedrooms . Num�eto s _.r..-_- Lot size .... - -- --- Water Supply: Public system El Community system ❑ Private Water Table 60 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 ❑ New Construction: Yes ❑ No FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if pu ' sever W.avaiiable within 200 feet.) ,�yy SepticaTar� Distance from nearest well ....0--_..Distance from f fipn_-----_/ ---Material--.. ...... Na•of•compartments: � -----Siz� 56 ra-.Liquid deptG� Capacity �J� r I L 1� /� t Disposal Fiel Distance from nearest wel� _ *.Distance from foundation.._ -._.Distance to nearest-Lot line.. _- ----- /41 — - —�j ---- ILL- Ty of lines._...i Len th of each line..---_? � Width of tren`ch_._._. �� S T e of filter material G - - epth of filter material._-_..�-(-j__ - Total"length.......Yp /Seepage P' Distance to nearest well..._ Q�_.-Dista om f ndation__. ----..Dist+ to nearePoin e.__-- _-.Depth- sA ----------- �� Number of pits------I..-__-......Lining material--r' -Size: Diameter... .... __ p -- t Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material-------------------------------------- EJSize: Diameter f s- Depth--------------- '--- ----: Liquid Capacity--------------------- ----gals. Privy: Distance from nearest well__, from nearest building------------- .,._._____......___..._f � ❑ Distance to nearest lot line ---------------------- - ---------------------------------------------- --------- ----------------------- a h- ---- C ----------------�---- -- - w ., R ----------•---- --- --------------- -Remodeling and/or repairing (describe}-- -------- ---- - -- _ � �IJ � s ----------- ---------------------------------------- -- - I herebycertifytha have re ared this appl cation and-that the work will be done in accordance with San Joaquin Count - q County— ordinances, tate laws,"iLrules and,regulations of the San Joaquin Local Health Di rict. l Si ned - --------- ----- ----- - ---------------------------------- - ontractor) 9 ------SMP'1'iCi="f A1KIK--S�RV/iCE,----- - ------ -- ----- - - BY 2915 F_MinerAve.P HO.6-3M'l /-- - °------ ----------- ---------- ----Title)---------------------- ---------------- -- - - ------ -----=--- (Plot plan, showing size of.lot, location of system in relatio Ings, et ca be placed on reverse side). FOR DEPARTMENT USE ONLY . 3 n APPLICATION ACCEPTED BY- +----------- -- ----�----�-rte----------------------------- DATE--------1- --- r�` ------ REVIEWED ----REVIEWED BY------------------------------------- ---- -- ----=-------------- ----='------ -----• DATE----------------------------------------------------------- "BUILDING PERMIT ISSUED I 1 DATE ------ ------------ - Alterations and/orrecommendtns: - f —� b :----- - �! --------------------� .......�- `-------- -. -- - f...4f --------------- -------------------------------- ----------------------------------------------------------- € ----------------- ------------------------------- ----------- ----------------------------- - ------------------------------- ------------- ------ - FINAL INSPECTION BY:_.__ !_ _--- ---- ----- --------- - ---------------- =----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.