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FOR OFFICE USE: �4-791-9�zS_ - ------------------------------------------------------- APPLICATION FOR S; i�ITATION PERMIT Permit No. ___.1. _` °.�._... (Complete in Duplicate) Date Issued __ _'_ a'_.=°_ _______________________________ ---------------- 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 described. This application is made:in compliance with County Ordinance No. 549. p s l —2-So- 23 JOB ADDRESS AND LOCATION --- ---- - ,C1.--------= f �U '�' ---� '---- ----- Owner's Name------/r/ .._ -a c -------------------------------------------------------------- `--------------- Phone---------`-------- ----------- r Address � ' d2`7- _ --------------------------------------=--------•-------•-----------•--•-------------------•--------•------- Contractor's Name---_,e12_,.--------• ---•-•-•------------- ---------------------------- •----------•-------------------------------- Phone---•----•--••--•-----------------•• I Installation will serve: Residence 81 'Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other[] 1 Number of living units: _�-____ Number of bedrooms _o�___ Number of'baths �___ Lot size __30�__"('__�._�_�___.----- - ------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ep- ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 95 Clay ❑ Adobe E] Hardpan 1 Previous Application Made: (If yes,date---_----------------J No �J, New Construction: Yes .[�] No ❑ FI-IA/VA: Yes ❑' No ❑ STALATION..AND SPE' TYPE ONoI slept cLtank"o ices cesspool perrnl tted ifOulblic sewer is available wi+hinm200.fee+.) Septic Tank:Tank: Distance from nearest well--v5'_-- --_Dista ro 'fou dation-------------------Material_._6�_�------------- - ,. No. of com artments_ __Pa �_ _._.Size� '��_�--- -__--_-___Li Liquid de th --- _.___-.____Ca acit 1Z C '. P q P. P Y --------------- Disposal -- i �- 9� ti Disposal Field: -Distance from nearest wells�0___.-._.Distance from foundation_E__�?�_... ___.Distance to nearest lot line ___________ ] Number of lines----- ______Length of each line__/_&-0-----------------Width of trench------2*�y__________________ ,.,.Type of filter materia} l//(.Depth of filter material____-�r- Total length_----- ----------------------- i: ---------------.-- Seepage Pit: Distance to nearest we�Izl#e ----------Distance from f undation__/0•________.Distance to nearest lot line__-4�________-_ Number of pits:__:____.__ Lining.material � p ] Size: biameter De th__•�1 " t Cesspool: Distance from nearest well-----------------DIstance from foundation-_-._---------------Lining material------_-----------------._-__________ ❑ Size: Diameter 4} Depth -:--- Liquid Capacity gals. Priv Distance from nearest well____________________I - - Distance from nearest buildin ❑Y 1--------------- -- y, -------------------------9---------------- --- --- ---------- Distance to nearest lot line----------------•------------------ --------=-------------------------- -- Remodeling and/or repairing (descrlbe)s---- =--------------- ---------------•-----•----------------------------------------------- --------------•-------------------=---- -----------------------------•--•---------------------------------- - -------- ._ -----------------1-1 ----•----- -• _....-..----.... -•------------ I-------------------------------------------- -,1 { I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations d'the San-Joaquin Local,Health Disfrict. (Signed)----------------- I'le-- - ----- -- -- -------------------------------------------------------- ---- ------------ -(Owner and/or Contractor) z: = - _ = — -: _{Title}.-�r;::.�.�----;----� _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --- -------- -------------------- APPLICATION ACCEPTED BY __;_ ,r ` __- DATE---- _�,«-�(a ------------------------_______ REVIEWED BY ---------- - - - -- -- ..............--------=------------------------------------------------- DATE--------------------- ---------------•----------------------- FBUILDLNG PERMIT ISSUED ==- - --- A Alterationi end/or recommendations:---------------------------- --------------•----------------------------------------------------------•--------------- ----------------•-----•------------- - _ %. -------------------------------------- ---------------------- ---------------- ------ ----------------------- ------------------------------------------------------------------------------ -------- FINAL INSPECTION BY:..-A41.1 ---------------------- Date--. _� _ - ---_-.----- --------_ _ -_ _ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT Y 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stacktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. -