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in 11%.1 "Now FOR OFFICE e ...............-... .. . .. ...P... APPLICAI i_ N.FOR SAK'ATION PERMIT Permit No. ...............................___ ---- .....I !Complete in Duplicate) ............I.................... ...... ...I ..- I This Permit Expires I Year From Date Issued 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. JOB ADDRESS AND LOCATION........3,12.3..........a.tj4..;.,,!;..................................... Owner's Name......... ..........ZAI�...... . . . ........... ....... Phone.).10---q.e.CU 0. ..... Address.__...............C.. Contractor's Name....... ....... ....... ................... Phone... rc,k�.......4....�Z aw Installation will serve: Residence Apartment House [] Commorcial [3 Trahii'r Court 0 Motel 0 Other 0 Number of living units: Number of bedrooms...?:n Number of baths ._L. Lot size .......................... Wafer Supply: Public system 0 Community system 0 Private Nr Depth to Water Table .60 ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam 2' Clay 0 Adobe[R' Hardpan[3 PrGvjouaAppPcafion Made: (if yes,dote.... ... ..._......) No 2New Construction: Yes Fa' No [] FHA/VA:Yes 0 No 9 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....S-O.-'_Distance from foundation------I. Material........ No. of compartments..........1 `o[_'..Liqu;d d.pjh...._4.'L.........capacity....B-00 Disposal Field: Distance from nearest weII...;i_C7.'. ..-Distance from foundation..._ 0.........Distance to nearest lot line.......;2-C.�..'. Number of lines...........I Length of each line..........1.0...........Wid+ of trench................A-1..*....... Type of filter material...3L;��k...Depth of filter material------- length----------------------.7, .0............ Distance to neo-est wall...jV_0. ........Distance from Distance to near Seepage Pit: I from fpundafion....110..� nearest lot Number of pits......I...............Lining Size: Diameter...... ........Depth.......... fte, 19 Cesspool: Distance from nearest well................ Distance from foundation _.........Lining material..................................... 13 Size: Diameter................................... Depth........................... .............Liquid Capacity......................... Privy: Distance from nearest well......_..._....................................Distance from nearest building._.._... ................................. 0 Distance to nearest lot line....... ............................................................................ .........w------------------ ........... Remodeling and/or repairing ....... ... --------------.. - ------------------------------------------------------------------------- ----- ................ .....*...................----------------- ............................................................................ .. ........................................... ................................................................. ............. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Late laws, and rules and regulations of the San Joaquin Local Health District. it. f (Signed).......... .........f_........ - :.`.-f:......._.._ 10 or and/or Contractor) .............. �C- By:. ........ ..... ------------- ..(Title).........i "T_ system in relation to wells, buildings, etc., can be placed on reverse side). fEF (plot plan. showing eas of lot, location f FO ,DEPARTM�N`f USE ONLY APPLICATION ACCEPT�-- ...................... DATE-9."VI Z�?................... . . .......................... DATE....... BUILDING PERMIT ISSUED...... ............. 6. REVIEWED BY........................ .................. Alterations and/or recommendations;.._......... .. .. ........................ ..................____................................................... .......................................... ........................ ........... ......................................................................... 60 -.1................___.......... ................. .. . ...... ................ ....1............................. ............. ...... .......................... ................................ . . .... ... ......... .................. ........................ FINAL INSPECTION BY;�- ate . ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 6. 1601 E.Hauaan A,.. 300 Wed O.k 51,..1 124 S,,.m.,.$1...1 205 W.,,91h Snot Tedi,C.101-i. Marl..,C910..ni. 171..,CWIW.i.