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FOR OFF.!CE US • -) , - ✓ Permit No. .. .._. .... --- -- - --------- -- -- ----- - --�s- �3.--a �APPL.iCATION �CO�K-_�TA�NIT�A6TION PERMIT --------------------------------------------------------- (Complete in Duplicate) Date Issued ..--__ l ----- ___________________________ ___ 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 County Ordinance No. S49. /01/ J0 ---- ---- �JOS ADDRES LOCATION.... -- ------------- ------------ - ------------------•- -- ----- .+---�- ---- Owner's Nam Phone. -------r d-a Address.......................... ........ Ialot`�---------•----------------------------..----------------------------------.................... .-�._ ---------------•----•--•--------------•- Contractor's Name.................... ---------------•---------••- -----------------------------.--------------------------------- Phone................................... Installation will serve: Residence A Apartment House ❑ Commercial El Trailer Court ❑ Motel E] Othe Number of living units: _1__-- Number of bedrooms .Number of baths J._ Lot size ........... ..[__ ___._. _ ._ Water Supply: Public system ❑ Community system ❑ .Private D� Depth To Water Table ------_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)4 Hardpan ❑ Previous Application Made: (if yes,date------ ------------) No New Construction: Yes No E] FHA/VA: Yes C3 NoX 11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspl ool permitted if publ'c sewer is available within 200 feet.) r Septic Tank: Distance from nearest well Distance from foundation----/10-------_.Material----- '- -..__ t1 b'm................. No. of compartments-------,�._-.------Size..__ Y _X Liquid depth_f 'r-----Capacity.l e _ Disposal Field: Distance from nearest well-.-. Q_--Distance from foundation....................Distance to nearest lot Ii ............ ZNumber of lines------------------------------ Length of each fine-------._-----------.-.-----..Width of trench.-=-...r -�__ �-_-_------.-- Type of filter material----,?0_4 ----Depth of filter material.../ __A--._---Total length----------fry. J. a_-11-.-----.___- Seepage Pit: Distance to nearest Distance from foundation--------------------Distance to nearest lot line__-----_...._---- ❑ Number of pits-.-•------------------Lining material-----.-----------------Size: Diameter------------------------Depth----------.-----------..._._----- �Vl Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------- ............... (, ❑ Size: Diameter--------------------------------------Depth-----------------•--------------------------------.-Liquid Capacity------------_---------------gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building---._----------_---_-_-._--------_----. \ 0 Distance to nearest lot line ----- ------------------------------------------------------------ ----------------------------------------------------------------- ------ Remodeling and/or repairing (describe):---- �_ _ �-G�----- -�-------------------------------- ••-•--------------------•-•--------•--••---•-------- -•-----------•--•-•---•---•-------------------------------------------------•----------------------- - ------------------------------------------------------------------------------------------------------------------ •-----------------------------------------------------------=4..............------------------------------------•----------------------------------------.........-----------------------------•-------•-•----------------- ---------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------- V---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. / (Signed)...-_ ---.--(Owner and/or Contractor) + BY; = -------------------------------------------------------------------(Title)---------------------------------------- ---------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTM T USE O Y _ DATE '��- -- -- APPLICATION ACCEPTED --�---- -- --------- �--- -- -- ----- ------ -----------•-------- -- --- ------ ---- �-- REVIEWED BY------------------------ ---- - DATE ... ; BUILDING PERMIT ISSUED D T -- ---•- f /�� .. _. :..-._.. - Alterations and/or recommendations:--- _C-- _._ �- _ __-_-. �• - ---- - --• / --- ---- --------------------•--•--------••-------------------•------------------------------ --- ------------------------------- = i ---------------------- ----------------=------•---..-..------------------- ------ - ------- -------------- --- ----------------- ------------ ------------------------------------------ -----•------------------------ I • k FINAL INSPECTIO . .----- -- ----- ----- ----- ---- ----------- Date--A�__ ----- - ----- -- ---- ------- ------------ SAN JOA IN LOCAL ALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Stmt 205 West 9th Street Stockton,California Lad[,Californias Manteca,California Tracy,California a E5 9 REVISED 8.59 21A 9.62 ATLAS