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APPLICATION FOR SA <br /> NI PERMIT Permit No. <br /> f 1 (Complete in Duplicate) s ~ <br /> Dat�`�"s`sue`d"-- .-------- <br /> l a{ion is hereby made to the San Joaquin Local Health District <br /> 549,a permit <br /> to construct and install the work herein described. <br /> This application is made in compliance with County O d <br /> - ------------ <br /> .__--._.---------------•----------------------------•------•----.-- <br /> JOB ADDRESS AND LOCATION----- li .�----------- <br /> ----------------- Phone----------------------------------- <br /> 0 w n e r's <br /> ----------•---Owner's Name_­14a4- - ----------------------------------- <br /> - <br /> Address---- ---------------3 -6-_- � <br /> 7Phone_. - <br /> . ��-= __ <br /> - <br /> Contractor's Name---- <br /> House ❑ C <br /> Installation will serve: Residence Mme-Apartment Commercial ❑ Trailer Court 0Motel [3 Other [I <br /> 1'"_ Lot size -----~tea--�----- x----- -- <br /> Number of living units: _/----- Number of.bedrooms __ -- Number Depth to"Water Table -------- ft. <br /> Water supply: Public system M Community system ❑ Private ❑ <br /> pp y: Clay Adobe Hardpan ❑ <br /> Gravel Sandy Loam ❑ Clay Loam ❑ Y ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ ❑ <br /> Previous Application Made: Yes ❑ No [� <br /> New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , <br /> (No septic tank or cesspool permitted if public sewer is available within ion feet.) h <br /> I i ,Jt-c-�-�- <br /> ,r <br /> Septic Tank: Distance from nearesr well !�D`:a�--Distance from foundation"___�4"..--------Materia-----------�- ------ -------•-- <br />' Distance <br /> of compartments----- --------------Size__._-3 --x -------Liquid depth_-----`6- ----- """--- Ca acs <br /> Width of french___._c�"- <br /> Dis osal Field: Distance from nearest weil__"�ezx_._Distance from foundstion______�-s-�.---•-�--Distance to nearest lot line____ <br /> P Length of each line <br /> Type <br /> -i�---- p� <br /> Number of lines-------------I- -� ,r- ------- g 4V <br /> Type of filter material.__- _Y-------3..-Depth of filter maternal_._--" -- dotal length________.c��-----•-- <br /> i <br /> Pit: Distance to nearest well. �&— -Distance from foundation_i �ef- Distance to�ep est to line-- ./_4__.-__ <br /> ------- <br /> Seepage _Lining material__ '""'.-- <br /> Number of pits._.._I----------- <br /> Cesspool: <br /> Distance from nearest well------------------- i Distance from foundation ------------__Liquid Capacity_---__..___.____----"------gals. <br /> ❑ Size: Diameter Depth <br /> Distance from nearest well_..-------------- ------------ ----------- ----Distance from nearest building------------------ <br /> , ----- <br /> ❑ Distance to nearest o ins--------------------------------------------------------------------------------------- <br /> -------------- - - <br /> --•------"------------•---•------------•------•-•----- <br /> Remodeling and/or repairing (describe):-------------- ------ -- --•-----••------------•-----"--- - <br /> -- ------------------------•--------------------•------:--- <br /> ----- --- • ------ <br /> - • --------------- --•--------•------------------------------------------•---------------- n - cco--------------------------------------------oui <br /> I hereby certify that I have prepared lli the San Joaquin nh wokcal Healthwile done <br /> }n�trt accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations _".-_"-(Owner and/or Contractor) <br /> (Signed) ---------------- -- <br /> ----------------------------------------------------(T�t <br /> e _ <br /> -- - <br /> buildings, etc., can be placed on reverse si e). <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> FOR DEPARTMENT USE ONLY _ <br /> DATE.----------- -I --- <br /> 5 ----------- <br /> ----------------------------------------------------- <br /> ---- -------- <br /> APPLICATION ACCEPTED -- --- --- --- -- -- - DAT ---------------------------------•----- -------•- <br /> ----------------------------------------------------- ------- <br /> REVIEWEDBY -------------------------------- --------------------------- -- -- -- -- -- -- ----------------- ------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------- <br /> -- --- --- - - <br /> Alterations and/or recommendations:__-._._.- <br /> ---- ---------------------------------- <br /> ----- <br /> ----------------------- <br /> -------------------- <br /> ------------------------------------------------------ ----------------------- <br /> J /F+ <br /> Date-------- -- <br /> FINAL INSPECTION BY <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8!4 Nor+h "C Street <br /> 132 sycamore Street <br /> 300 West Oak Street Tracy, California <br /> !30 South American Street Lodi, California Man+eca, California <br /> Stockton, California <br /> ES-9-2M <br />