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FOR OfFICE USE: - --------- 4 APPI-16AT16N FOR, PERMIT Permit No. ..7 ----------------- ------ ................. - -------------- - ------- --------------------------------------------------------- (Complete in Duplicate) / i - This Permit Expires I Year From Date issued Date Issued :7��... -- ---------------- ------------- ------------------------ Application is hereby made to rthe San Joaq'uin '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. A6 LOCATION_.. ---1-7 ---------------------------------------------------------------- JOB ADDRESS --------- -A---------!� Owner's Name , •-------------------------------------------------- Phone -- -----------------__-------------- ------ Address-- - ------------ ----------------- Phone_YA ---------- ------------------------------------------------------------------f.... Contractor's Name_ a_ Installation will serve: Residence Vf Apartment House ❑ Commercial ❑ Trailer Court El motel Ur Other ❑ Number of living units: ---- Number of bedrooms Number of baths Lot sizeZ jp ------------------ Water Supply; Public system Community system E] Private E], Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam [-] Clay Loam.E] Clay [] AdobeZ Hardpan 0 Previous Application Made: jif yes,date---_.___..,__._'.- ) No I-] New Construction: Yes E] No FHA/VA.-Yes ❑ NOD TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e - Tank: Distance from nearest well-________________Distance from foundation--------------------Materiai-----------------------_----------------------- Tank: No. of compartments--------------------------Size----------------------------------Liquid depth----- __---------------Capacity----------------------- .i t qD';s pp,I�o I f ield: Distanceest lot line___________._____ from nearest well-----------------Distance from foundation--------------------Distance to near (4 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-----.-.---.-.---------------------------- '57 Seepage Pit: Distance to nearest well-, ^4e.....Distance f rpm f ndation__.,�k_�P-------Distance to nearest lot line_________________I ## %-9 r;; To Number of pits,-.-./--------------Lining material__ :.PZ---Size; ......a2_X-_'------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------- -----------Lining material--------------------------------- ❑ Size: Diameter-------------" -------------------!.Depth_-------.------------------------------------------Liquid Capacity------- --------------------gals. Distance from nearest welL.------------------ Privy: Disf -----,---------------------Distance from.nearest building------.._---_____________________..___.._. . 1 -- El Distance to nearest lot line.------- ---------------- a------ -•------------------------------I------------------------------------------ ------------------ Remodeling and/or repairing (describe):------------------------ --------------------------------------------------------------------------------------------------------------------------------- -�-- .7 ------------------------------ ------ --------------------------- ----- ------------------------%-------------------_-------------------------------------------------------------------------------------- - - ---------------------I--- ------------------------------- - ---------- ------------------------------------------------------------------ -------- ----------------------------- -------------------------------------------- ----------------------------------------------------m----------------------------------------------------------I------------------- ----------------------- --------------------------------------------I------------------- I hereby certify that I have prepared this applicatio; and that the work will be done in accordance with San Joaquin County ordinances, at laws, and rules and regulations of the San Joaquin Local Health District. �ws, an A, --- Owner and/or Contractor) (Signed)____ ------- ------------ - ----------------------- < C, By:--------------------------------------------------- -------- ------------ .?,/------------- --------- - - - ----------------- C., r u (Plot plan, showing size of lot, location of system in relation to w-IJ 7 u ings, et an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__---- --- ------- = -------------- ---------------- REVIEWEDBY---- --------------------------------------------------------------- ------------------------------------------------------- .. DATE_--------------------- ----------------------------------- BUILDING -----_-------------------------- BUILDINGPERMIT ISSUED.----------------------------------------------- ------------- --------------------- ---- DATE---------------------1......-----------N----- -- ----------- Alterations and/or re4:ommendations---------- ..... ------------- ------ /��-------------------- -----------r---------------------- --------------------------------------------------•-------_-------- -------------------------------------------------- -------- ------------------------------ -------------- ------------------------------------------------------------------------------------------------- -------- -------------------------------------------------------------------------------------------I- ---------------------- ------------------------------------------------------------- - --------- ----------------------- ---- ----- ---------------------------- - --------------------------------------------------------------------------- --------------------------------------------------------------- Date--- -- ---- ------- FINAL INSPECTION --------- ------- -------- --------------- -------------- BY:-.-. - ---- ------ rAN'�JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVIEM0 9-59 3M 3-'63 F.F.00.