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OR OFFjICE USE: --.---.-.._ 1 - _. - _. APPLICATION AOR° SbNiTAT10N PERMIT Permit No. __ ..�_ -------- ----- -------------------- --- (Complete in Duplicate) y --------------------------------------------------------- This Permit Expires l Year From Date issued Date issued ----__ �1�5 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 County Ordinance No. 549. JOB ADDRESS AND LOC1 N _ l ---------------------------- Owner's Name . �` l�f ------------------------=-------------- Phone------------------------------------ Address ------Al......... ----------------------------------------•------•----- Contractor's Name Installation will serve: Residence C]—Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ Number of bedrooms _A Number of baths ---.?- Lot size -------/o—ep --------------- Water ----Water Supply: Public-system �mmunity system ❑ Private ❑ Depth to Water Table -------- 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 ®J New Construction: Yes ❑ No ©- FHA/VA: Yes ❑ No El— TYPE lTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan . //,,',, Distance from nearest well---- --_Distance f m fc ndation___,P49__--__.Material-.-.�,�t� ©� ��^AlCo. of compartments--------7�---------Size-------i '�-Liquid depth--.__`�-----------Capacity_dW_e�,/ Disposal Field: Distance from nearest well________.—-----Distance from foundation____'.[?--------Distance to nearest lot line---1:5----- Number --Number of lines--------�/-------- ----- .Length of each line_-.-- P/y--.--------_ Width of trench-____�--glv Type of filter material---/4e,0P,yt�.._Depth of filter material---fef---N--------Total length--------. 45._.`_------ Seepage it: Distance to nearest well.-._____--------Distance fr foundation___.4�./_.Disfance to nearest lot Number of pits.-----__/______----------Lining material-- Size: Diameter----- iDepth------G __---------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------lining material-...------ ----------- ----.El f Size: Diameter----------------- -------I-----------_De th---------------------- - -_- _ . .------------------Liuid Capacity Privy: Distance from nearest well--------------------- ---------------------------Distance from nearest building-.--------------------------------------- d ❑ Distance to nearest lot line------__-_- Remodeling and/or repairin (de r' e): . 6� ------ ----------------- ---- .s= . 9"= - -- regia r r--------------------------------- g -------------------------------------------- - -------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a and regulations of the San Joaquin Local Health District. �/ (Signed) ------- ------ - � h A `------ i``�`-e---------- - ----------- ------------ .-.{ wner and/or Contractor) r Sy:------------------- --- -- •- - (Title)---- (1 Q/ (Plot plan, showing size lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- r,~ DATE = v 1 REVIEWED BY ----- - -------------- DATE - - BUILDING PERMIT ISSUED------------ DATE. Alteration and/or recommendations:_--- r ..3- - - -.- _e_=_ - I _ - ----------- ------------ ------� I" --- f —`jam' `C� c 7 ` '` ^ i L �—�" ' --------------- - ---------- --- ` -�'e1. --•--------------- ------------------------------------------------------ ----------- --------------- ------------------- ----------- ----------- ------------- -------------------------------------- FINAL INSPECTION BY-- --- ------------- -- � ---------=---- -•---------- -- .- Date......... ------------------- - ------------ - - --- -- ---------------------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California F-F-ca. e