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1-UKUJ-1—ICE USE: ---�_-.�_,3__ -t`-- - --. t --� - APPLICATION FC) SvITATION PERMIT Permit No. ------- .- i --------------- - (Complete in Duplicate) --- --- --- This Permit Expires 1 Year From Date Issued Date Issued _/�3_ - Application is hereby made ikfo 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 A D LOCATIO Owners Name__0-_6 -------------- I: ------------------------- --- ------ ---- -•• - ------•--- Contractor's Name__ -----------------------------7----- --•-------------------- ------ Phone Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... Number of bedrooms ;;�--- Number of baths f.-_--_ Lot size _____1 / �� ---------------------------- Water Supply Public system ❑ Community system ❑ Private �epth to Water Table 64_6ff. Character of soil to a depth!Lf 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe �Hardpdn ❑ Previous Application Made: (If yes,date- >-___- ----.I No ,�,� r� l�ew Construction; Yes No ❑ FHA/VA: Yes ❑ No [s�� TYPEOFINSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance ,from neares# Distance from foundation_ ----____ Material ___________________ _ 4 No. of compartments._.`.�----------------Siie,_,:3_.�(,5-�-�"----Liquid depth------51'---.1 ------- --..Capacity--•-- -----j7 � Disposal field: Distance from nearest`we'll .470-- Distance from foundation__-_ - --.Distance to nearest lot aline__- T' e of fit lines---�._- ---- - --_ - '*.Length of each Irne-------`�..O-- ------.Width of french._. _ ._ yp niter;material._ ©.C,e ,-_--_Depth of filter material___ _ ___"_____Total Iength_____._9a' ------------- („ ; -. 'rV o nearest well_IPO__�___.____Distance from found'ation___ld--s--.-,Disttaance to nearest lot line__��_._� 1 eepage Pit: � Distance t j s P ----Linin materia--I-_ /,--- �' r Number of 1ts---- ----- ---- g �pG_ _C Size: Diameter----__.. --- ------ Depth-- --�s'�--- ------ - Cesspool: Distance from nearest welt.__.___-________Distance from foundation___________________Lining material__._-___.-- ----------------------- ❑ Size: Diameter---------------- ------------------ Depth--------- -------------•----------------------:-----Ligwd Capacity --------------------------gals. Privy: Distance from nearest well.:._ ._.,.__._.._--_--------------- Distance from nearest buildin _____ 9 ❑ Distance t� nearest lot line •, '� ----------- -------- -------------------------- ---- -: r -_- Remodeling and/or repairing (describe];____... ►. ---------------------- --------------------------------------=- 41 -- ---------------------------------------- ----- ----- -------------------- ; II __ i' this - ca - -- a --------the-------------------------------------------------------------------- ----------------------- ------- I hereby certify that I have pre tired this application and that the work will be done in .accordance with San Joaquin County ordinances, State laws, and r fesLand'-Ab;'julations oft a San Joaquin Local Health District." ii 2 (Signed)------------------------- - f- 3 (Title) ------------------------ -- --- ------------- ---------- - "-------------------------- F------------- Owner and/or Contract . ' By:--------------- '- ° °r) -- ---- --------- ---------------------------- - -------{ e) = {Plo+ plan, showing size of lot, location °f system in rela+ion to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY. t APPLICATION ACCEPTED BY__.___ # DATE_- l----_ . ------------- `' -- -------------------- ------ ----- �---- -- ------------------- ------ REVIEWED BY ------------- `-------------------------------------- ------------ ---------------------------------------- DATE Y- BUILDING Alterations an or recommenda ------- �--- ---- DATE: --- �PERMIT ISSUED tions:.- -3 --------------- �>✓z� '-` -� ' - •'`--''�`��`-- .:— s -------------------- --------------------- --------- p---------- ----- ------ ---------- � i , � r C� ----------- 'FINAL INSPECTION BY: -- Date--------- i AN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hasalton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California', Tracy,California F.P.0 Q.