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., ,.r Permit No. _- -a.- ----- 1TATION PERMIT (Complete in:Du licate)-.,. t APPLICATION FOR SA P� Date Issued •-7•--- .* � - _ SBS 2-10-021� r T : � 9 -: Application is hereby made to the San Joaquin Local Health District for a permit to const�uct and install the work herein described. pp This a lication is made m co mpliance with County Ordinanco o. 549.70rJOB ADDRESS AN LOCATION__: zz� ---------- --- -1-- rf 1 PC.� --- J_ � _ . __ Owner's Name 1 . '�- ' --------------------------------------------- Address ------------------------------------ --------------------- I ra , � L=- , �! z,�, ----------------------------------- ---------------------- Phone. ,-----=--•-- Contractor's Name----------------------�f��-----=-�------�'•------= --- - , Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Others❑ r Installation will serve: Residence ❑ p i, 1—Number of bedrooms _-�-- Number of baths __ Lot size _�3- - 7 ••'�=-'-'--�-------•---------- Nurnber of living units: 1 � _ Water Supply: Public system ❑ Community system ❑. Private, Depth to Water Table -- ft. Clay Loam ❑ Clay E] Adobe Hardpan C-]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ndy Loam E] .w Previous Application Made: Yes [01 No New Construction. Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND-SPECIFICATIONS: r' (No septic tank ar�cess ool Permitted if public sewer is available within 200, feet.) P P � P (may , r ] �''�` -/----- ----Material-6-------- Distance from ne'aQST well" ,""""'Distance from-foundation_ - Ca adt '-_-- --• No. of.compartmen�s> _- -- �-------Liquid depth f p Y - �� Disposal Field: Distance from nnearest well__-- -__-.-Distance from foundation --------Distance to nearest let line----------------- Number of fines-----`=I- -- ` Y`n = Length of each line----/ ---��----Width of trench---- �, ---------------------- Total length__ .S r = t --------- -----------------�----------`------ Type of filter materials{•_9Cri---Depth,of filter material_., f -=P 4- See ale Pit: Distance to nearest well_,,/( ---��stance £r mfoundation----mac'-------------Distance to nearest lot line--.--_----------_ rl Number of pits---- ----- -----_Lining material_ � 4-/-S.lie:`Diameter__,-_'R�.-?--------Depth-_-�C z ---------------- f �, I„ S, Cesspool: Distance from nearest well---.-._--' -'Distance-from foundation-.__ _, LinN. ;ng material----------------- _----__.----- ❑ Size: Diameter---------------- ------------------- bepth-�-----, '� /quid Capacity gals. - Distance from nearest well-----------------'�-- `--------- Distance from nearest building------------------------------------------ --------------- ❑ '' ---------------------------------------- Distance to nearest lot kine-------- -`----------------: -- ------------------------------------•--i---- - e ----- --------------------------------------------------------------------- Rem odelin -----------------•------------:-----------------------Remodeling and/or repairing (describe):--_-----------------=--- = ---- - � ' - --------------------' ------- ---- -------------------------------------- — = _- e - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St tis, and rules and regulations of the San Joaquin Local Health Di`str . ' ' A------------------------------------------------- ------------ caner and/or Contract ] � T/ -- (Si( ned -------- _ / -----%-Oor -�— ..� L /1t—t1_: -------------------------------------(Title) ? BY:-------------------------•----v ---------------- T (Plot plan, showing size of lot, location of system in retation to wells, buildings, etc., can be placed on reverse side]. - FOR DEPARTMENT USE ONLY r ,1 DATE------------- 4------------------------------ --------------------------------------------------------- APPLICATION ACCEPTED BY DATE------- --------------------- BY----------------------------------------------- ------------------- BUILDING ---- `-------- ------- ----------- REVIEWEDi ---------------------------------------------------- DATE.------V-----------'----------------------------------- BUILDING PERMIT ISSUED-------------------------- -',-------- _ =� - Alterations and/or recomme ations----------------------------------------------------------- ------------------ ------------ 1 4-� �-r/ = -------------------------------------------`---------- `' � D1,g-1 FINAL INSPECTION.-BY------------------------ = Date--- ----------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 NortS "C"-Street 130 South American-Street 306 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9--2M Revised 1.57 F.P.CO.