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FOR OFFICE USE: _ Permit No. t APPLICATION FOR SrNITAION PERMIT --------. (Complete in Duplicate) Date Issued -- S--Y --=-- - _ - - --------------.._- This Permit Ex ices 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 County Ordinance No. 549. V Z� N :D --------- ------ ----------------- JOB ADDRESS ASND-L"OCATION____._:_ _____ -_�------ ------ Phone-----•------------------•----------- '�-a- -------------- ---------- Owner's Name----- -_________ Address------------------------`f ----------- •------ •-l- •A--_ ---------------------•------------ — r� fr, ------ Phone----------------------------------- Contractor's Name �'--1 �"r1__I -I-- `-t�1 Installation will serve: Residence N Apartment House 171 Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: ___I-___ Number of bedrooms _° Number of baths ___I___ Lot size ____ -Q-._--X____I_Q_�'---------------------------- Water Supply: Public system ;dCommunity system F1Private E] Depth to Water Table - - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jNf Hardpan ❑ : (If yes,'date_---_----17------- No New Construction: Yes ❑ No V FHA/VA: Yes E] NoZ Previous Application Made TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well. _--___--___Distance from foundation___________________.Material____-.__._.______-__-___------------------- -- ❑ C.414-0 � No. of compartments-.-___________________ __ Size-------•------------------------Liquid depth-------------------------Capacity----------------------- �l Disposal Field: Distance from nearest. well-.)�fl*t-Distance from foundation___- �______--_-Wid h #f nearest lot line_E_3__'------- 6XfS Number of lines....----- ------------ ``----Length of each line--------=.%-p------ Width of trench-------• = --'-------------� Type of filter material___-.---_ ____--�-Depth of filter material--tKRc - '-CTotal length__________________________ _�f_____ i v I See a e Pit: Distance to nearest well___/1�4-,JAF4 _--Distance from foundation_____ ______-.Distan�e to nearest lot line__- -1---- p g�xISr��Number of its--- ---------Lining materiel__�S--ke/(_.Size: Diameter.......` ---------Depth .-.-_.-_.---?- ------------ P Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----_-__---.___---_--_-________.-__ _Liquid Capacity gals. DI stancle from nearest wei4____-_-.-------------------e th `--_---Distance from nearest building---------------_--------- -------------- Privy-. " • k' -- ___________________ _--___--_________--___._.-__..-------------------- Distance-to __-___.___-___-___. Distance.to nearest of lire--- --- -- -- - -------- ---- ------�..._ ------------------- ----- S St'S� - Remodeling and/or repairing (describe) 7 '----- -- -Ff l i----------------- ----------- -•------------------------------ Y :r r - ---------------------------------on------------•--------------------------- epared this application and that the work will be done in accordance with San Joaquin County I hereby certify that I have pr ordinances, State laws, and rules and regulations of the San Joaquin;Local Health District. ---------------------------- (Owner and/or Contractor) -- ------ - (Signed) - ---- --------- ------------------------ n - ---- -------------(Title)�------ ------- ------ -----"---...- --- --- ---- _ - = _ -. By:. �-. j-: - - --- . .. . — . F . (Plot plan, showing size of lot, location of system in relation to wel{s, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY } .. f - -------- ---------------------------- - � DATE-----`-�--------- I APPLICATION ACCEPTED BY-- ---------- ��`� ------- ----------- ------- - DATE ------------------------ REVIEWED ------------------------ REVIEWEDBY------------------------------------ ------------ BUILDING PERMIT ISSUED------------- ------------------------ ------------------------------------------ D'ATE. Alterations and/or recommendations: = _:__- _= "_-`'---`T=------_ ------- ��" :- --------------------------------------- -------- ------------------- -------- = _ ' : ------------------------------------- -------- f _._. r - ------------------------------------- ---- ------------------------— — ------ ------------------ --------------------- I ---------------- ---------------- f --- `---- -`--------------•-------- --------------- ----------------_ -- FINAL i"NSPECTfO"N"—BY":--.__-..__._:'-:--- -_ -_ SAN JOAQUIN LOCAL'HEALTH VST.RICT 1801 E.Ha:alton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California y F.P.C O.