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FOR OFFICjUSE: - _ Permit No.-------------------------- ---- APPLICATION FOR'SAN17AT10N PERMIT------ ------ ----- ----- (Complete in Du lica+e p ) Date lssu d This Permit Permit Ex ires 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N__..___. -• ----- Phone_ a� r f- ---------------- Owner's Name---------- -- - - - -- - ---- - -------- - Address--------------------- -- -•------------------------- - .. Phone-----�-----•-- Contractor'sName_ Other Apartment House`❑ Commercial ❑ Trailer Court [I Motel ❑ Installation will serve: Residence [� p -/Q__-____•- -- - _--------------- �_ Number of baths _ _- ____ Lot size ___-� Number of living units: __ -- Number of bedrooms _.. th to Water Table _5A ft• Water Supply: Public system ❑ Community system El Private g? hep aCla Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ No ❑FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date--------------------) No D--"New Construction: Yes ❑ I� TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material_____________________ __ apt' nk: Distance from nearest well-----------------Distance from foundation________________ No. of compartments-------------------- -- Size --Liquid depth--------------------------Capacifiy_. Disposal Fi d: Distance from nearest well_�5.-_ �---Distance from foundafiion____,l�-`-----Distance to nearest lot line Length of each line___ ' ------- ,� t Width of french_.__-- - --' f Number of lines-------- ---- g Q T e of filter material_- -__ C15.1---Depth of filter material__-_._>/ -_.-____-Total length- Type ength____._- 5--- (\] f ----- YP �* I Pa Pit: Distance to nearest well_______________ Distance from foundation ---.Distance to nearest lot line------ --.__---- Number of pits Liningmater•sal----- --- Size: Diameter--- Depth ------ Linin material-------------------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation___---- Liquid Capacity__-______________._---'---•als. \ -------- ❑ Size: Diameter---------------------- ----- Depth [ `' Distance from nearest building------------- Privy: Distance from nearest well_______________________ - ----- Privy: ------------------------------- ❑ Distance to nearest lot- ine-------------- ------ ------ ------ - � . „ r-d ----------------- --------- •--------------- Remodeling �-/-- -�- -- - --- Remodeling and/or repairing (describe:- `*C '-'�- ____________________ ------------ --- ------------------------------- ----- - -------------- J --•- •------------- --------------- T -- •------------- ------------- - q----------------------------------------------------- ------------------------------------------------------------------------------------------------ } I hereby certify that I have prepared this,application and that the work will be done 1n accordance with San Joaquin County ordinances, State laws, and rules and regul +dons of +he San Joaqui i Local Health District. -- ----- r and/or ontractorl -- ( wne o (Signed) -- Plot Ian, showing if lotlocation of s sem g , can be p„ ed on reverse tin*relat' wells, buildings, etc., side). ( P g sze o , Y t .. _ 4 Ar FOR DEPARTMENT USE ONLY .. ---- APPLICATION ACCEPTED BY- - - ------------------ ------- -------- DATE-- --��:------�-^�_ -------- -------- - ------------------ REVIEWED BY--------------------------------------------- --- -- ------ ----- --- -------------=--- BUILDINGPERMIT ISSUED------------------------------------------------ ------- ----------------------------------------------------`' Alterations and/or recommendations:----- -------------------------------- ------------------------ --------------------------------- G ------------------------- ------- ----t-- �/-_� _._.--- Date------------- ------- -------------- FINAL INSPECTION BY--- -- -�--- --- - g r SAN JOAQUIN LOCA HEALTH DISTRICT r - •+ — 20S West 91h Street 309 West Oak Street 124 Sycamore Street 1401 E.Hozellon Ave. Lodi,California Manteca,California Tracy,California Stockton,california