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- -—-- _'R''_00 OFFICE USE: - APPLICATION FOR-S!_�NITATION PERMIT Permit No. 1 , -------- --=---- t. {Complete in Duplicate) -..-- This Permit Ex fres i 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 wit*County Ordinance No.-549, z-- n l !- JOB ADDRESS AND LOCATION-1- OwnerOwner's 's Name------- �- --CL.- �---------•--------- ----------------------------------------------------- ----------------- ------------------ ----- ----- Phone-----••------------------=---------- Address------• -•-•--------- Qa � - i Contractor's Name [ •••�} �----------------------------- -------------------------------------- --•--- Phone---------------.----•-------------- Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ / -------Z1 I ❑ Other ❑ Number of living units: __ .___ Number of bedrooms N2 Number of baths _.._ _ tot size ._____ - 19� 11 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy—Loam ❑ Clay Loam 0 Cla ❑ Adobe ►[ ardpan ❑ Previous Application Made: (If yes,date-.--- ........) No New Construction: Yes Io ❑ FHA/VA: Yes 9--KO ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted.�-if-public-seweras_available_w.ithin-200 feet.)_- o �p y� - Septic T : Distance•from nearest we7ll___, ----Distance from foundation_______.__._-Mat r al' �Q�C-.J p of compartments_-? Size_ J-. �--Yd---Liquid depth______.__-- -_ ___ Dis osal Isld: Dis ` f 1 / �� "- Capacity---�------�----- � No tante,from nearest well__a�__ _Diss ane from foundajion-_____� _-_..--.Distance:to nearest lot li e_�__.____--- Q � - r�__ _-- Lengt _ f ea h Im'e _ 1, ___-Width of.trench. . - Numberof lines- -_ 7. '` Type of filter material_____JA ____'_-_Depth of filter material___J �J/.--.Tota€ length___._--/_ - - ----- rp - , ------------ / _ Seepag Distance to nearest well-j-0_______DistanCe m foundation__!a __ __ _______.Distance to nearest lot line-4__ '-------- -T` Number�of pits__ -- ^- -- —i _.--- = . ---_�. Depth ca Cesspool: Distance from nearest well _______________t.Distance from foundation-------.------------Lining material--------__-----.__________-__________- �{ ❑ Size: Diameter = Depth = - ------------------ -------------- Liquid Capacity-------- --.gals. '! Priv Dis±anee;fromnea est well�. _____.._ y' ---------------------Distance from nearest❑ building---------------------------- Di -----------._.'� Distance to nearest lot ------ -------------------- ------------------------- ------------- -----------� k r', Ile Remodeling and/or repairing (describe]:__.: ---------- - .. t j r ` k 4 wti e .._.___------------------------------------------________________________________________ . -- _________________________________________________________________________________ _ _____..__ - __________________r--------------- -- _'.__.-_.________.____-_.,___.____________--___.-_______________________-___________-____________-------.-.-_.__..____ I hereby certify that I have:prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ` an rules a ulations of the San Joaquin Local Health District. E � w (Signed)--------_ ----- t --, � -- -- - -- - - - -- ---- - - -------------------- By:-- ---------- -----•--------------- - ---------------------Owner and/or Contractor) { 8y•--•-•------* = `.Y =;% AZ � - Title)-- // ----- tom -. (Plot plan, showing'sizeTif''liit; loc tion of system in rrelation to , huildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION AC EI'TED BY llC ' - --- ---------, _ �?` C 1 ----- ------- DATE---- - ---------------- REVIEWED BY-------- --------------" - r - T DATE - , BUILDING PERMIti ISSUED ----'------------------ - -------------=------------- ----------------------------- QATE------------------------- -------------------------------- ,;-7Alterations and/or recommendations:____--_ ---__` - _ ---____- i=-u-r--_-� � - fl-s- r --------- - - -- --- - ------ --- ----- ------- r �-- s ----- ---- ---------------- — --------•---•------------------------------•- ------------- t — ------------------------------ -- --------------------------- ------------------------ ------------------------------------ . --------------- - -------------------------------------------------------------- FINAL INSPECTION BY: `�� - Date.------ ------ -------------------- ----------------------------------- _ JOAQUIN,LOCAL HEALTH DISTRICT t 1601 F,Has eltan,Are. - Oak StreetEi 144'5 camore Street�_` Y L 205 West 9th Street Stockton,California , Lodi,California Mantecw,California .' r Tracy,California j ES 9 REVISED S•S9 3M 3—'63 F.P.CD. t k