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1� FOR OFFICE.,USE: " --------- ----------------- --- ----------- �(/ " -------------------- ------------------------------------ APPLICATION FOR�Sh;NATION PERMIT Permit No (Complete in Duplicated ---- ------- - --------- bate issued ------- - -----�-•-C� 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 descried. This application is made in com Iia ce with County Ordinance,No. 549. F—SLA L Otvtv y P ' c= " 'l -------------------------------------- JOB ADDRESS AND LO ATI ' Ny Owner's Name-------------------- _ �_ _ .R --------- F ------------ ----------------- ".'i------- Phone---------------------------------- ` Address _S__1 -..-. �... �` �> / SQ N a R -------------------- ---------------------------------------------•--•----•------- Contractor's Name------- - -��-E ..- ----- -------- ----------------- Phone----••------•---------------------- 1. Installation will serve: Residence I- Apartment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I __. Number of baths �s Lot size ___�p_____A`� ��--'-------- " Number of living units: ___ Number of bedrooms _ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table✓_ _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam - lay ❑ Adobe❑ Hardpan I Previous Application Made: {If yes,date___________________) No New Construction: Yes EA-11-6 _E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: -�= (No septii'tank cesspool perrn'It+ed`if public sewer is'avallab7e witkin Z00#eet:J Septic nk: Distance from nearest well.__1�Q- .__Distance from fount3ation_..-I --------.Mater 1-- ,r0_A - �/ No. of compartments_._.__. Size__��__)l_ _- --Liquid depth____ --_` ____Capacity----1.2 q 0--- Disposal Field: Distance from nearest well--10_0_._._Distance from foundation__ __ Distance to nearest lot line__-_.._ + Number. of lines__________________________Length of each line-3P_�_-9_p -----Width of french.------ .11_.._._._-- Type of filter:'rnaterial__ j' Y�.-__Depth of filter material-___.__�_�_.__.._--Total length-----___...� ------------------ Seepage Pit: y Distance to nearest well---._/,0�____--Distance from foundation____________________Distance to nearest lot line..___.-__ Number of pits.-.-- --.--- f Lining material= .-_5ize: Diameter_ X __-------Depth----- - - ------------ --- Cesspool: Distance fromnearest wet!_________________Distance from foundation___.________.__.___Lining material--__...-.__.__-___.____..-______._._ 4; ❑ Size: Diameter------------••.-----------------------Depth------------------------------ --------- -----------Liquid Capacity----------------------------gal Privy: Distance from Inearest well-..._.____-_______________________-.-----------Distance from nearest building----------------------------------------- ❑ `\ Distance to nearest lot line-- ----------------------- ------------------------------- ------------- ---------------------- ------------------ 4` Remodeling and/or repairing (describe):-------------- -------------------------•---------------------------------------- ----------------------------I------------------------------------ ----- I---- ------------------------ ------------------------�------------------------------ c ` --=I------------------------------------ ----------------------------------------- -------------------------------------------•----------------------------------- ---- ---------------- ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ------------------------------------------------------------------------------- ordinances, State.laws and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------ --------- ------- ----- -----------------`'---------------------- ------(Owner and/or Contractor .. „r__P�r" �r,^w1®r1�F�l�wr--------- _ `��wr�Itle ---.----------------- ---------------- ------_ ( (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed.on reverse sidel. 4 I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_!--T._ -. ---------- ---------------- ---------------------------- DATE ��--'I ..` 1�------------------ rI REVIEWEDBY-------------------------- - --------------------------------------- -------------------- -- ------------ --------- DATE--------------------I------------------------------------- BUILDINGPERMIT ISSUED ------:--------------------•---------------------------------------- DATE----------------- -- Alterations and/or recommendations------------- r ------ ---- A.-Zfl..-(�f- ��T5.-------13------�---� -6`� ?--------TcJT-P--=--------- -------------------------------- I ------------------------------ -- --------------------------------------- --� ----------- - -------- --------------- ----- -- -------------------------------------------------- ------------- - ------------------------- - ---- ------- ----- ------ -- ------- ---------------- ----------------------------------------- FINAL INSR-CTION BY: - _ - ---- -- --- 4'!/v Date-------/-rte= r---- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Wig, , Tracy,California r k sM