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FOR OFFICE USE: _ate0ft .--_ _ .__--___.--. __--_-__--. APPLICATION FOR. SAN ITATTRMIT-` Permit No. . 4 /Y ..Q -------------------------------------------------------- (Complete in Duplicate) - ------ ------ D This Permit Expires 1 Year From Date Issued I -�� Date Issued ---�----=----------- Application is hereby made to the San''Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_-__' ---------------------------------------------CJ I �U� X ----- --------------- r k Owner's Name------- l/-/xr, �Q -----------------------•-------------------' ----- � _ ----------------- Phone. f Address------------------------ Contractor's Name Ci` Ci` ------------------------------------------------------- ------------ Phone----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: _/---- Number of bedroomsNumber of baths _-7, Lot size -__1 ---X -- o__r----_- t Water Supply: Public system ❑ .Community system ❑ Private Depth to Water Table 7,?_ it, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [*Hardpan ❑ Previous Application Made: (If yes,idate--------------____) No [j�- New Construcfion: Yes E34o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is a�sailable`'wifhin 200 feet.) I i Septic ank: Distance from nearest well--- from foundation---/0-_----':---Material_ _lee�w1-� No, of compartments------- --------.__Size._:;l-`t'�3^�9_�-_-:---Liquid depth--- ------Capacity.-2 } Disposal field: Distance from nearest !i_w-__.._Distance from foundation---/Q_-__-_--_-Distance to nearest lot line__S� Number of lines_'__--____. -- _ -------- _ Length of each � ` = _-1v' lJW idth of trench ------------- ` Type of filter materiarr�- r.Depth of filter material----._/f "----_....Total length---------��{Q _----____ \,\ '�3 Seepage Pit: Distance to nearest well-.-------------------- from foundation--------------------Distance to nearest lot line_-________-_-__._ ❑ Number of pits... -------- -------Lining material----------------------.Size: Diameter---------------- -----Depth- ------------------------------- Cesspool• Distance from nearest weft---i--------_....Distance from foundation--------------.: Lining material-----__-------__-__--.__..______ ❑ Size: Diameter.__' ----------------- -- _--Depth--------------------------------- ----_Li Liquid Capacity q P Y --------gals. Privy: Distance from nearest well-------- ------ ---------------------------------Distance from nearest buildin ❑ Distance to nearest lot line-------- ------------------------------------------------------ ---------------------------------------------------------------- . x ( r Remodeling and/or repairing describe :------- ' ------------------------------------------------------------ ------------------------- ------------------------- ---------------------•------- 4 t ---------•--------------------------------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, )3;��U. les and re ulations o the San Joaquin Local Health District. r (Signed)- ------------ -- ------- ------------------ - ------- (Ow . 4�V �} µ �. I! - _ ..-_ and/or Contract ner a /o or) I 0y:----------------------•----------- Title - ----------- ------------------ ------------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------- ----- ---------- ----------- ------------------ --- - ---- DATE------ R EV I EW ED BY ----- DATE--- ------------------------ BUILDING PERMIT ISSUED--------------2...--..._ --- = : DATE --------------------=----- Alterations and/or recommendafions:r-------------------- -------------------------------------- I ---------------------------------- FINAL INSPECTION BY:....__ -�-�- e,,5— ------------- -------------------------------- Date--------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California