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/,v „�NITATION PERMIT Permit No. -- - .. .- ` APPLICATION FOR -- �� - " (Complete in Duplicate) �_ �__ • Date Issued rr APp licakion is hereby made to the San Joaquin Local Health District for a permit to construct aril install the work herein described-.- `x 1 � ('his application is made in compliance with County Ordinance No. 549. S. _qi � G41 &,.,, I---------------------- JOB ADDRESS AND LOCATION-- --�---- -- ------------ Owner's Name----- ----------- -- Phone__ .c'_.....---------'-------- Address. 74-_ -. . ---------------------------------* = Contractors Name - Phone. ... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ �Meotel [3 �Other ❑ ,Number of living units: -A---- Number of bedrooms '�-.--- Number of baths ---F-.-- Lot size ------------------------------------- Water Water Supply: Publicsyn+em Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand 177 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [i].-Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes gNo ❑ f TYPE OF INSTALLATION AND' SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tan Distance from nearest well-----------------Distance from foundation---------------.._-.Material--..-_.-:.-------------------....----.-.-.--_.-..M No. of compartments---------- ---------------Size------------------------------_.Liquid depth----------------- -------Capacity---------- Disposal Fiel Distance from nearest well-----------------Distance from foundation----------_-------- Distance to nearest lot line--_----.-------_- c Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------.--.--------- Z Type of filter ma+eriaL_-----------------------Depth of filter material':-------------.------dotal length--_--------_-------._.--------_-------- -- See �ip-aacleJ�pit: Distance to nearest well --------Distance from foundation- A-4-!-iL__Distance to nearest lot liJ1---------- -----------�r E -- Number of pits---1 ---------------Lining mate ria l-_ �.--------Size: Diameter----•--Q-............Deptn------- ---------------------_-.- esspooi: Distance from nearest well-----------------Distance from foundation------------ --.Lining material-------------------------------------- El Size: --_____-__-------_---------_------.❑ Size: Diameter-- ------ ------- ------- ----------Depth-------------------------------- -------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------_-----_i__--..-------------Distance from nearest building.-_----------_.------___--.__----.-_-_---. ❑ D]stance +o nearest lot line--------------- --- --------------------------------------•------------------------------------------------------------------------ -�---- -- '`" ---- Remodeling and/or repairing (describe):_�`''�'�i=---' ----�`�• •- -- � *"--� - 9 y��„1 - � -- --- ----------------- ----- ------ l ------------------------------------•---------------------------------------------------•------------ ----- -- ------- ------- ---------------------------------------------------- -------------------•---•--------------•---------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordina to laws, and rules and regulations of the San Joaquin Local Health District. (Signe )-- - `-"-- -------- �--------------------------------- ----- ( and/or Contractor) BY= ----- dt" {� Title Ali F� --------- ----------- I (Plot plan, showing siz f lot, location of system in relation to wells, buildings, etc., can be placed on rever a side}. F FOR DEPARTMENT USE ONLY 1 DATE--- 4 --•------------------------ --------------- APPLICATION ACCEPTED BY--------------------- -- ------ iREVIEWED BY-------------------------------- - ----------------------------------- DATE --------------------_:.. BUILDING PERMIT ISSUED---•-------- - DATE Alterations and/or recommendations-------------- --- --- - -------- ------------------------------------------ --I----------------------- -- --- a. ------------------------------ -- ------- - --------`------------------ ---------- =�..- 1 `' - ------------------------------- �FINAL ENSPE-CTION Date BY:..-- - ,�5----•--------------------- rte.- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E" 9' 145446 ATW...