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FUR OFFICE USE: ........... <br /> ..... ...................... ........... ................ <br /> ..... . -------­------ --------------------­---- ..... APPLICATION -FOR SAWAT40N PERMIT <br /> Permit No. <br /> J <br /> ......--1....................... ................... (Complete in Duplicate) <br /> ............................ ------••--•-----I-••• This-Permit Expiris.1 Yeai-From Date Issued Date Issued <br /> Application is he"reby made to tha;*S6,n Joaquin Local Health District for a permit to_ construct and install the work herein described. <br /> This application is made in compliance with Cout-Ordinance No. 649. <br /> JOB ADDRESS AND; OCATON, le 4 e0 <br /> &A-4.................. <br /> Owner ......... PhoneX ,f <br /> s Name--'.. _6 <br /> Address............. ......... .. ....... <br /> .............. <br /> ...... .... .........................................................k------------------------ <br /> Contractor's Name......_ -.* ................---------------------------*-----------------------*.................................. Phone.................................. <br /> Installation will serve: Residence 0 Apartment House E:] Commercial [:] Trailer Court [:3 Motel 0 other fflkaC4,� <br /> /46V4t <br /> Number of living units: .....__. Number of bedrooms --------- Number of baths _/.--- Lot size <br /> Water Supply: Public system [] Community system E3 Private ga--Depth to Water Table Ivxft. <br /> Character of soil to a depth of 3 feet: Sand On Gravel E3 Sandy Loam E] -Clay-Loam [] Clb.y--O Adobe C] Hardpan IM <br /> Previous Application Made: (If yes,date...........I........) No UB'—New Construction: Yes Q'-N �0 FHA/VA: Yes F No Ug,-- <br /> TYPE OF INSTALLATION AND_-SOECIOICATIONS:_" <br /> (No septic tank or cesspool permitted if public-iev�i�. is available within 200 feet.) <br /> 4) <br /> No. of compartments......_2............. --------------*--------- <br /> Septic Tank: Distance from nearest well..� 'i� Distance.from unclaflon-_40........Mater" I__ ___C....._.____......_.._._. <br /> ' <br /> ...........I...Liquid depth_.__. ...... _ve <br /> Size3A <br /> Disposal Field: vr��` apacty__...y.... ...;.- loo <br /> Distance to nearest ]cif <br /> Distance from nearest Distance fr6ff46undatidnr: <br /> Number of lines............/--------------------Length of`e-a­c*1ino_a..0--.__' Width' of-trench.',_.,.f,--,:,, <br /> ­/....................... <br /> a erial.��­. .........._Total Type of filter materialS.$a&{_)Aa. _f't" ial I,ngfh_..: V, <br /> Depth of filter ?n_t <br /> Seepage Pit: Distance to nearest ."fo <br /> .................Distance from unclation_d_.-57?___-------Distance to nearest_Ioffine_/00...�.. <br /> umber of pits---- ------Lining material...__.. . ... ...... .. <br /> < .. . .......Size: Die <br /> Cesspool: Distance from nearest well............."--Distance from foundation....................Lining rr�+eri�@...-------------------............... <br /> Size: Diameter.............................. ........................ Liquid CaPocjty.............................gals <br /> Privy: Distance from nearest well.-_ .............................Distance fr,6rh ne .- <br /> arest'61 uilding............................... <br /> ❑ Distance to nearesf lot line.....----.....................------- <br /> j <br /> Remodeling and/or repairing (describe)........................ ......................................................... <br /> ...................................... <br /> ---------------------------------............................................................................ ..........------------................................... --------- <br /> .............�;----------------------------------------------- I...........................................................................................�­........................................................ <br /> .......................-----------.....................-------------------------------------------------------------- -------------- .........................................----------- <br /> ........... <br /> I hereby certify that I have prepared this application-t and fhat-46e-workwill-be done in-accordance with San Joaquin CZfy <br /> e los a regulations <br /> ordinance's, State laws.'and rules a of the San Joaquin Local Health District. .7 <br /> (Signed)..............( ... . . ....a ------_----------------- ......... -------.(Owner e6i <br /> X - --------------------------- <br /> By:................................................. <br /> ........... <br /> -------- <br /> (Plot plan, showing size of lot, location of system in relafio'n.fo wells, buildings, etc., can be placed on reverse side). <br /> FOR <br /> DEPARTMENT USE ONLY <br /> APPLICATION,,KCCEPTED <br /> .... ....................... <br /> REVIEWED BY.... <br /> ------------------------------------------------------------------------------------------------------------------------- DATE-_ <br /> ------------------------------ <br /> BUILDING PERMIT ISSUED-_-_--_ DATE.._ vt�� <br /> ------ .... <br /> Alterations and/o, recommend' jons:.....t.................:.....................................:..:t....................... <br /> ...............................:..............................................I............................................................................................................................................ <br /> ............................. ........................................ ----------------------------------------------------------------------------------------------------------- ....................................... <br /> ......................................... <br /> -•--...---•...............................I--- <br /> FINAL INSPECTION <br /> BY:._ .0... . .....�...tI......... ........Date .......................... <br /> ------------- ................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton Ave. 300 West Oak Street 114 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.F.C G. <br />