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1-UKUN-JU USE: y f --------------------------- ------- R-SA „� .� .. ...___�_c_ lu`lD.�' J APPLICATION �dNITATION PERMIT Permit No. .. ...... ------ --------------------------------- --------- (Complete in Duplicate) ------ <� --- - This Permit Expires 1 Year From Date Issued Date Issued A__7--�5--, Ap lication 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. JOB ADDRESS A N � f --------------------------------------•--•----- Owner's Name-- --- --------•- - Phone-------------------------------•• Address 1t�------- -------------------- -------� •-- -- ------ - ---1 �� Contractor's Name � 1L,1 D - .---•-------------------------- ------------- ---------------------------------------- ------- Phone..---.. Installation will serve: Residence [�J-�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __�____ mber of bedrooms Number of baths __(-__ Lot size __(a.�'� C �� -"------------ - Water Supply: Public sysfealEff Community system ❑ Frivate ❑ Depth to Water Table � t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpa ❑ Previous Application Made: (If yes,date___________________) No New Construction: Yes� ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest "' ell Distance from foundation- v-------. fprial._. __. r --- No. of compartments__---..__J-__ _.__Size1�, '_-__.___Liquid depth_ .___-_______________Capacity__,C ------- Disposal d: Distance from nearest well._. Distance from foundations----------Distance to nearest lot line__-��_____ Number of lines------ -______________ Length of each line----� - _-..Width of trench_.c , - - --------------- Depth of filter material- l _/�'l Depth of filter material-__ __ ______Total length_._. sJ__ ______________ ------------------- See page Distance to nearest well ___:n-::�-----Distanc y m o ndation_- � ante to nearest lot line_ /__� . i Number of pits----QZ�-------Lining mater e .__ l Size: Uiamete -----------Depth_. -------- ------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---_-.-_-___-______._---___-________ ❑ Size: Diameter-------- ----------------------- Depth------------------------------------- - ------------Liquid Capacity.-. ------------------------gals. Privy: Distance from nearest w4-------------------------------------------------Distance from nearest❑ building__________-_--_-_____- ----------------- Distance to nearest lot line_--- ------------------------ Remodeling and/or repairing (describe):__ _.---_ p_� ------------------------------------------- •--------------------,- -------•-------------- -------------------------------- ------------------- ----------------------- ---------------- ----------------------------------------------------------------------------------------------------------------------.----------------------------------- I hereby certy VTnd' n��cared this application and that the work will be done in accordance with San Joaquin County ordinances, Stare ulations of the San-9oaquin Local Health District. 7 (Signed)______ __________ er an / r Contract j By:. Title (Owner 0 or ----------------------- (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 " APPLICATION ACCEPTED BY --- ---------- --------------- -_------------ --------------------------------------- DATE 5�7------- REVIEWEDBY-------------------------------------------- ----------------------------------------- ------ ---------ZATE----- - ----- BUILDING PERMIT ISSUED------------- DATE � . Alterations and/or recommendations:--- - ---_ - - `�_/y, f - ---------- -------------- ------- ----------------------------------------•-------------- --------•----------••----•--•-------------------------------------------- ----------------------------- ---- ------ ---------------- --- FINAL INSPECTION BY:-- �.: _.-._ Date_. ...... 11 SAN JOAQUIN LOCAL HEALTH DISTRICT Y 1601 E.Hazelton Ave. 300 West Oak Street. 124 Sycamore Street 205 West 91111%Street Slockton,California Lodi,California Manteca,California �• �� Tracy,California F.F.Ca, l '