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FOR OFFICE USE: l = ' Z_ APPLICATION FOR S�NITA 1 Permit No. . ./�/. ... - ------------------------- � � �ON PERMIT --------------------------------------- - (Complete in Duplicate) Date Issued ------------------------- ------------------------- --- This Permit Expires 1 Year From 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 with County Ordinance No. 549. 141 JOB ADDRESS ND L CATION f2 ' -----------------------••-•••------------------------------------------ Owner's Name_____________ -� Address ,. ---------. _ . Contractor's Name-------------------------- eZlr>.. '�, '' ----------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence M-Ifpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __`_ Number of bedrooms _3--- Number of baths _-- _ Lot size .1-4r >e'�----------------_____._-____--__-_ Water Supply: Public system ❑ Community system ❑ Private [L'Depth to Water Table -oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8 ardpan ❑ Previous Application Made: (If yes,date------------------._) No [!r- New Construction: Yes [J-7No ❑ FHA/VA: Yes [lis No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_47r-----Distance from foundatio __-fA--------Material_,,*t2f fr ---------_--_-- �� No. of compartments--.,Y--- ---------- S i,e_,_0 Wfe-_-4Y_ ANLiquid depth-----7"-A'.............. .__- �' i Disposal Field: Distance from neares well._, �___-Distance from foundat'on� rQ_ .._.Distance to nearest Igt line____J ...... Number of lines----..�_ , ___ ___ Length of each line_.-__ ___ A_�,P_XAVidth of trench. Type of filter mate ria lA� Depth of filter material-_./_09F'__!__Total length_-e��_-_'no_________________________ i Seepage Pit: Distance to nearest well ---- Distance ........ line---Lining matenal_-.iP�1,!'__ -__Size: Diameter_.�.�__ __.__Depth__;_*�I---`__________________ W Cesspool: Distance from nearest well----------_------Distance from foundation--------------------Lining material------------------------_............. ❑ Size: Diameter._..---------------------------------Depth----------------- ----------------------------------Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.--------------------- _____________ ❑ Distance to nearest lot line------------------------------ -- Remodeling and/or repairing (describe):-------��1 Z11& �A /---4. ----------- --------------------•---- 9� ---------••-----------•-----------------------•--------------------------------------- --------------------------------------------------•------------ -------------------------------------------------------------- ------------- ---------------------------------------------------------•----------------•----------------------------------------•--------------------------------•--------------------------------------------------- --------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations 9f the San Joaquin Local Health District. (Signed)------------------------------------------------ ---------- ----- ---- --------------------------------------------( or Contractor) BY: -- - - -------------------(Title) ------ ------- -- --------- (Plot plan, showing size of lot, location of system i a-ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------- DATE----- - .2/` REVIEWEDBY ------- ------------------------------------_------I--------------------------- ------ DATE-------- ---------------------------- BUILDING PERMIT ISSUED---------- ------ - - DATE ----------------------- &Alterations and/or recommendations:_ _. { _ .. _.� / ' <f��l ------------------------------ ------------- ----------------------------------------- ----------- --- - --- --------------------/- - ----- --- - - --------.._.. - ----- -------- -------- -•------------------��-� ---•- ------------------ ----------------------------------------------- --------------------------------------------------------------------------- -------- ---------------------------------------------•----------------------------•----------- -------------------------------- --------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------_----.-------- ---------------------- ------- ----------------------------------- ------•---------------.------------------------------•---------------------------------------------------- ------------ ------------- FINAL INSPECTION BY: --------- Date-------------- 41 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.