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FOROFFICE USE: Z <br /> ;*TION­r RMIT 13 <br /> -APPLICATION FOR SANII Permit No. ..................... <br /> ---------------- ----------- ----- ------------ [Complete in 6uplicate) . .Date Issued ------- <br /> ------ ------- ----------------L---------- --- This Permit Expires 1 Year From Date Issued <br /> ,A�piicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is madein compliance with,County.Ordinance,No..549. /3/ -- 330 — 01 <br /> )OB ADDRESS AND LOCAT9W_. <br /> Owner's Name--------- . ...... --------------------------------------------------------77-7.77.7-ftone <br /> Address........................ -------------------------------------- <br /> -­ ----------------- 7...717---------------------------------- ------------- <br /> V,e <br /> -------- -- <br /> Contractor's Name-------- ------- ---------------------------------------Phone..622 <br /> j -Commercial Ef Trailer ,Court E] Motel [3. Other <br /> Initallaflon.will,serve- esidence,F]. Apartment House <br /> ......... <br /> Number of livir�g'unifs: -------- Number of bedrooms ----!!4.Nu'm 6er ofjba;' s ........ Lot size ----------------------------------------h� <br /> - - *1' <br /> Water-Supply: Public system* m-bV 6;rn -system El Private 1% Depth to Water Table -------- ft. <br /> — ;­�4 V I <br /> !Character of soil to a depth of 3 feet: Sand-E] Gravel.0 *Saniiy,Lo_am E]_Clay Loom C-] Clay F] Adobe]ff Hardpan E) <br /> 'Previous Application Made":­(If <br /> ------_--------I No- E] New Construction: Yes E] No [] FHA/VA: Yes ❑ No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p ( A IF <br /> Di - ri� Vesf',-'well---6;6--+Distance from four . ........... <br /> Septic Tank: stance froni-' �a idation---- Material----4f&6&_Cx..... <br /> No. of compartments------- _,'�----------- Liquid clepth-------4---0--------___Ca aci V-- ---- <br /> :. jo-1�4_ - C� 11 <br /> Disposal Field: Distance from neare-i it`�yeII__6&__*Distance from foundation...j.6_/±: <br /> '. ..Distance to nearest lot <br /> Number of lines........... -------------._-_-Len th <br /> ----Length of each line____-_idM._ W-Width of french------ <br /> j� Type �f filter mate ri a L_jVA0>C,4----Depth of filter material------- length---------45A?�-----------------_ <br /> rSeepage Pit: Distance to nearest well-I-----_-----------Distance from foundation-----------------_Distance to nearest lot line__._____.._...... <br /> .1 El Number of pits------------------I----Lining material------ ----------------Size: Diameter------------------------Depth----- .......................... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- --------_-._Lining material.._____.....________................. <br /> Sze: Dia..w. ------------------De th----------------------------------------------------Li uid Capacity- --------------------------gals. <br /> iz ameter-------------------- <br /> .Privy- Distance from nearest well-------------------------------------------------Distance from nearest building._____.____________--_--_---------_______- - <br /> F1Distance to nearest lot line--------- ----------------------------------------------------------------------------•---•----•---------------------------•-----------•---- <br /> i Remodeiing <br /> ------------------------------------------------------- <br /> Remodeiingand/or repairing (describe);--------------------------------------------------------------------------- -----------------------------------------------------•........................ <br /> �4-----------------------------------------------------------------------------------------------------I--------------------------------------------------------------------1------I---------------------------------------- --- <br /> ---------------------------------------------------------------------­--------------------------------------------------------------------I-------------------------------------------------------------I------------------ <br /> ----------t-----------------------------------------------------------------------------1------------------------------------------------------------------------------------------------------------------------------------ <br /> I,hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> i <br /> (Signed)...__------ -- ----- ----- - ---------------------------------------------------------------------------------------------------_(Owner and/or Contractorl <br /> ------------ ----------------------------------- ----------------------------------------------------------- <br /> (Plot plan, sho g size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ? <br /> APPLICATION ACCEPTED BY. ------------- -------------------- DATE-- . ------------- <br /> ----------------------- <br /> . ..-----------------•-------------------------------------------- <br /> REVIEWED BY---------------------------------------- ---------------- DATE---- ...........................------_------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ .......... DATE--------------------------------------:-------------_------- <br /> Alteraflonsand/or recommendations:------ ---------------- --------------------------------------------------------------------------- ----------------------------------------------------------- <br /> ------------------- --------•-------------------•-------------------------------- ----------------------------------I------------------------------------------------------------:................................. <br /> ------------------------------------I----------------------------------------------------------11-----------------------------------------­--------------------------------------- -------------------------9---------•------------­-------------------------------------------- -------------------------------------I——--------------------------------------------------------------------- <br /> --------------------------------------------------------1....... ­ --- -- -------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY ...... .... <br /> /L---------------------------------- Date------- --- --- ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Am orl can Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stiest <br /> Slotkf*n,California Well,California Manteca,California TraWr California <br /> ES 9 REVISED S-159 2M 6-61 ATLAS <br />