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FOR OFFICE JJSE• --_----________:-- APPLICATION 'FOR YANITATION PERMIT Permit No. ..f L((.U-_/ --------I -l(�`-a- l-------- (Complete in Duplicate) // -...�"...�..Y ----------------------------------------------------- -- This Permit Expires 1 Year From Date Issued 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. �j r --- �4....' 708 ADDRESS AND LOCATION �,a` ---- -•---- --------- Owner's Name._._._.- `. ----------------------------------------------------------------•-------------•-----•----.... Phone.110._. Address---------- = -c -e=d-�L-•--••- ..... Z'-............................*-------------- Contractor's ••----------------------•-•---------------•-•- Contractor's Name---- B -P!a.. T - -- --•------••--------•------------------------•----------------•-------..------ Phone.................................. Aw.k Installation will serve: Residence ®partment House E] Commercial'❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___[___ Number of bedrooms ___I___ Number of baths -----1. Lot size ... __ _ _X_./.Q_.'.-_____________________ Water Supply: Public system ❑ Community system 2--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 R] 'New Construction:+,Yes E3--`�o ❑ FHA/VA: Yes ❑ No �'c�• TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet) Septic Tank: Distance from nearest well_________________Distance,from foundation__________L'____.Material_______.--:______-_ ..................... No. of compartments - �Size--------------------------------Liquid depth--------------------------Capacity....................... Disposal Field: 'stance from nearest well---. Distance from foundation......k_._.....Distance to nearest lot line`........... ® 4,P Number of lines---------------- -____ --Length of each line_.---- .�/�? Width of french_______Z_�_________________ ' A-J",,"�1 Type of filter material._._];___Depth of filter material-------1•j ........Total length_________¢-1__�______________________ Seepage Pit: Distance to nearest well---------------------- from foundation---.................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material---------------.-------Size: Diameter-------------------------Depth-----------------------------_--- 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.......................................... ❑ Distance to nearest lot line-----------------------------------------------------------------•-------•--------------------------------------------•----•---------------- Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------•----•--------------------------- -----------------------------------------------------------------------------------------------------------------•-•--------•-----•----•-••--•-•-••--••-------------------------------•.................................... 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, and pules and regulations of the San Joaquin Local Health District. 1 (Signed)-------------------- (Owner and/or Contractor) -- - ------------ ••-------------------- ....{Tttle)-------------------------------------•--.---.------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----J. ---- —---------------------------------------------- DATE--.-//-- —------------------ REVIEWEDBY -------------------_----------------------------------------------------------- DATE-------------------------------- BUILDINGPERMIT ISSUED----------------------...---------------•----------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or reco trlend'ations:______-- --- -- --------.- ------------------ ---------------- �. - ,�-_.-- ----------------------------------------------------------------------•-- •-------------------------------:------------ ---------------------------------------------------------------------------------------------=------- ---------------------------------•-•-•-------- 61 FINAL INSPECTION BY:---- - .-. _._... = ------ Date-- ._.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Smoot 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [5 9 AEvIBEa 5-59 2M 5.61 ATLAS