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FOR OFFICE USE: /� _ �jZ �'LICATION FOR SANT2 TION PE.—AT Permit No. ... ................... . -- - --- --------- (Complete in Duplicate) Date Issued 7._1....-.4.1, 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 compliant with County Ordinance No. 549x7/, ]=5�L01� Ll� /VJOB ADDRESS AND LOCATIO /- --5'rE-'�1-I .G.11 -.___ .. -- .... --hF----/_C' �5 Owner's Name-------------R-'--------- —•--------- ------ --- ----------•------•-•--------------•----- - Phonef3f7.;V 6 .- - --��'. Address T ., �. N� ff -----COYA_4--:- Contractor's Name - - -----.C/Lr3tt/�i.F- .C't.=-------- -------- - -- ----- -------------- - ----- - ----- ----------------------- . ............ Phone_-- ------------ --------------- Installation will serve: Residence V�—Apartment House ❑ Commercial ❑ Trailer Court ❑nnMotel ❑ Other ❑ Number of living units: __ l_.. Number of bedrooms _�Z_ Number of baths -/---. Lot size -_. Water Supply: Public system ❑ Community system ❑ Private ErDepth to Water Table __.... . ft Character of soil to a depth of 3 feet- Sand F-1Gravel ❑ Sandy Loam [ lay Loam ❑ Clay [IAdobe F] Hardpan Previous Application Made: (If yes,dote___ - - _ - . ) No New Construction: Yes t No ❑ FHA/VA: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic T Distance from nearest well........50, Distance from foundation--------A? _... Material --C-ONCRJ ........ Size. x I D X _ _Liquid depth..._._4,/1 --.- Capacity...L �- •• No. of compartments. '�,,_--------- 1111-:7— Disposal Disposal Field: Distance from nearest well...-5- ..-Distance from foundation---------�. _...Distance to nearest lot line.... / r — Number of lines ............./--------..____:._.Length of each line_. ._.._.__9gr -!__..Width of french..._...__.) ._..�..._....____.. I'L Type of falter material_...R -�---Depth of filter material---../9..._.....Total length_.._.. .__- — l l�___._._Distance to nearest lot line.............. .. Seepage Pit: Distance to nearest well.. -.1�. _....Distance from foundation.._.. .. /'JJ ❑ Number of p ts... ....f_._..._._.-Lining material.h -- Size: Diameter_. _..b----_--Depth----- _"n -1 -- ---- Cesspool: Distance from nearest well -------- ---_-.Distance from foundation -_....... .... . Lining material.. _.. ❑ Size: Diameter - - - - Depth ... --- - --------------------------------Liquid Capacity._ ----•-------------.-----gals. � Privy: Distance from nearest well------------ -. -Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line --- --- ------ ... ------- -------------------------------------_-----.._.......•............................. r Remodeling and/or repairing (describe)................. - --------• -----•--•------------------------•-----------•-••-----------••-------------------------------------------------- ----------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, a d r s and egulations of the San Joaquin Local Health District. (Signed). v .-.----.. (Owner and/or Contractor) _ �. _ _ - - Title ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY n . ...--------------- -------------- DATE-- ....--7 ...7......rte-� APPLICATION ACCEPTED BY._...�(-f.�.�-�- ----�-- •---••--- --•�-� ---- . �-�-- REVIEWEDBY----- -------- - ------- DATE....................................... ....---- ---- BUILDING PERMIT ISSUED-------- -- --------•------•--.-------------------------------- ------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:.................... --- • ----------•-------------------------------------------------------••-........----------------------------- .................•--............._ ..........................------.........--........................................................ .......... ..................•--•-•---•-•---..........................._........... . ------ ---...........---....---...... ...------.._................... .......... .... ............................ FINAL INSPECT �� 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 E.H.9 2M 1.67 Vanguard Press