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01kPeAPPLICATION FOR 5N TION PERMIT rmit No. 3- " (Complete in Duplicate) Date Issued ... _-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the ork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION Z / j� � ----------------- -- V 7 Owner's Name-------------- ' ----- ------------------ -- ---- Phone. 1�r7 v._. Address---------------"7-/-•.-� ----------e-- -- --- ----- ----- .:..- ' -----------------------------------•---------------•�---f-�---/-----•------ Contractor's Name Name .. ---•------------•- --------- PhoneY------------------------------ ------ Installation Installation will serve: Residence___s/__/��parfinent House E] Pommercial F1 Trailer Court ❑ Motel [] Other ❑ Number of living units: Number'of bedrooms _. Number of baths ___/___ Lot size _._ -5_ ,1(__ TS--------------------------- I --_______________________i Water Supply: Public system R?"�Cornmunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet:1 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--"Hardpan ❑ Previous Application Made: Yes ❑ No [l----New Construction: Yes l0 0 FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: { _f (No septic tank or cesspool permitted if """�c ppse//war is available within 204 feet.) Septic Tank: Distance from nearest wel;54X!-Di,tanc, from foundation--/Id-------_..Material--(r__ ----- ------------- ---- - ®� No. of compartments----cr�-�___ __.".____Size__S _ ._ __._:___Liquid dei? h_----�' 7!- --- --------Capacity------------ Disposal Feld: Distance from nearest well./.._ ----Distance from foundation---4R0_-____..Distance to nearest lot line--- Number of lines---------------------------------Length of each line--------- _------.Width of french-------Z`f--------------------- _ Type of filter materiaL-9i10`- ,,c -----Depth of filter material-----�_�_. ......Total length________.747.1_--___________________ See r : Distance to nearest weft'/'" ____Dista rom_ Na�on____ d_�_____.Distan�46 to nearest lot line-_._`S.__�__.__ Number of pits---'-/_______________Lining mat ial-- _----.__ e: Diameter__ 3_3_.......___Depth-----aZ_0- Cesspool: Distance from nearest well-----------------Dis a from fo anon----------._.-.___:.Lining material---------------------_;___________ ❑ Size: Diameter---- -------------------------------. -Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_______.___---_----_____-_-___-._._. ❑ Distance to nearest lot-lire----------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------- --------... --------------------------------------------------------- ----------- -----------•----------------------- ------------;-------•-•-----------------`------=-------•--------- ---------------------------------- ----------------------------------•---•-------------------------- E _____________________________________________________________________________________________________________________________________________________________________________________________________ _____________________ ------------------------------•_----------.-----_-' -------------•-------------------•---------___•_----------------------------------------------------------'---------------------------------------------------------- I hereby i hat ],have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a law , and rules and regulations of the San Joaquin Local Health District.` (Signed) wner and/or Contractor] --- ----------------------------------------------( wrier and/or Contractor) -------------- P� y CQ�---------------------- --------- By: --------- ----------- --------- BY: --- ----------------------•---- lT�tle} '+ (Plot plan, showing size of lot, location of system in.rei n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- DATE - A ------------- ' REVIEWEDBY---------------•------•--------- -- ------------------------------------------------------------- DATE----- --L BUILDING PERMIT ISSUED: ; DATE --`-----------------•--------------------- Alterations and/or recommendations: ---------------------------------------------------------------------------- ----•�J- ----------------- v -------------------------------•-------------------------------------------------- ------------------•----------------------------------------------------------------------- --------------------------------------••-- - ------•------ • --------•----------------------- -------------------•-------------------- ------------------------------------------ ------------- --- -------- ---- - ------- ------------------------------------------------------------------------------------------------------------- •---------------- FINAL INSPECTION BY:. Date-----PA--- -12 SAN JOAQUI LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Sfockfon, California Lodi, California Manteca, California Tracy, California ES---9-2M Revisea 1-57 F.R.CO. s -k