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(Complete in' uplie 11UN YIsKMIr Permit No.
<br /> , 1r
<br /> Date Issued l..!.. .-
<br /> P:ppl'rca+ion is hereby made to the Sen Joaquin Local Health District for a permi+to construct and install the work herein described.
<br /> This application made in compliance wit.County Ordinance No. 549, 74_70^) 2l 2 `140=Sj
<br /> 2•ClkrG{o�-.S'r: Cc.0-�+ft-f-E �/} "` �)//�� `.
<br /> JOB ADDRESS AND TION_
<br /> Owner's Name` ~
<br /> _llr j .._ ...._....._._... .............................. Phone........ �.. .....
<br /> ..... ..... ...............
<br /> Address.- Q_ `
<br /> Contractor's Name.._-
<br /> -
<br /> .,--_.. ......... _.._...., :...........'........Phone,............................
<br /> Installation will,serve: Residence Apartment House D Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <b
<br /> Number of living units',,__!Number of bedrooms.1.-Number of baths...�,_ Lo},size•..'.
<br /> Water Supply: Public system ❑ Community system 177PrivateAC Depth to Water Table. ft 1
<br /> Character of soil fo a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam"❑ Clay❑ Adobe❑ Hardpan❑
<br /> Previous Applicafion Madw Yes❑ No New Construction: Yes No❑ t
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet,) - I
<br /> Sept- -ank: Distance from nearest wall,_...S��,?--,.Distan f � o
<br /> ------.Mate
<br /> Nc.o. compar+mtrn+s......__. p�Aty
<br /> t Liquid doFsth.,..,,,_.
<br /> --.......-Sizq ._ .- � --.Capeety
<br /> Disposal Field; Distance from nearest wel[,.ggg a._..,.Disto o ndatio /7
<br /> Number of lines.... S,� Distance to nearest lot line,,
<br /> �'�•••• -••.. Length of each line.._.- .Q Width of trench..,..
<br /> -
<br /> T pe of filter maferi -
<br /> y _�, -Depth of filter material...,,....f 8.....Total length.....................
<br /> Seepage Pt: Distance f nearest a +_ Distance from foundstionDistance fo nearest lot line....-.-._--_.,.
<br /> ❑ Number of pits.--.,__-...........Lining•material._........ Size: Diameter_.............._......Depth............. _..
<br /> Cesspool: Distance from nearest wel3---_-___„_Di-0aace from foundation.,._=- s.Lining maFerial..........._.......,,_......._
<br /> ❑- Size:,Diameter;.-....__...._---.._.........__.De th�.,-- ...._-..__.__ Li uid.Ca aci
<br /> Privy: Distance f%nearest well..._..--..._....-.... ; 9 ,pr.,}Y:
<br /> _-_- _Distance from nearest
<br /> buildin
<br /> ” . #ll. _..g--.. ..- ..........................
<br /> ❑ Distance.to nearest lot line,__......_...:..- ,• ..
<br /> Re cli3g d/or re _. _,-......._..._ .........
<br /> _
<br /> f rte• /.,......_J_�.
<br /> , '
<br /> ................,,_._................_...__......,,................_...._.........__,.................
<br /> I hereb' cerfify that 1 have pfepared this applicafion and that the work will be done in accordance with,San Joaquin Comsfy
<br /> ordinances Stele lawms/and rulesrand.*ulafions of the San Joaquin Local Health District.
<br /> ,..,...(Owner andlor Contractor)
<br /> .....................-_..,.--• (Title)_.._...., ._.... '
<br /> )Plot plan.showing ire of lot,location of s _ - _
<br /> s.............. ............ .
<br /> — ysfem in relation to wells,bulldinga,etc„can be plied on reverse side),
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY_...............__...-..-_.._ .. .-......
<br /> REVIEINE�By.. __ _
<br /> -: DATE--....._..
<br /> ,.... -
<br /> 3UILDtNG PERMiT ISS{1ED_,_.._.._....___. '- , �..__...-..-....-_.._.._,.-...-.-
<br /> ....,.-_,_,......-_......, _....,...,_
<br /> Alterations and or -_--__-„,,,___,_,,,_.. DATE.-...__......,.-._.............__,_.._...-_”-.._
<br /> reeomnl0ad_,.".s:,._.. . ............._...,,.........._....
<br /> ......._.. __..... ._...,_....,.............-1 ---.......,,._..__ .._._,, ................................................._......„_,...........
<br /> _ .__.._..__................ ,-.............
<br /> ...... ..........._...1...._....._............................_ ,-.,,,,_.......,,..............................
<br /> l ,M_„_-., ..,,-._..........___..
<br /> FINAL INSPECTION BY:. .. ._ :...-, i Date....-..-_: I:~! ” .`..._- .
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 Sou&Americo.Stnet 300 Was+Oak Street
<br /> 132 Sycamore Street 814 North"C'Street
<br /> SToekfen,Glifornie W1, California Manteca.California , Tracy,California
<br /> ES--9-2M: 'Revised W-21W
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