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JA FOR OFFICE USE: ! Permt No----------- -�" ` - APPLICATION FOR S NN IT ----------------------------- ------ -------------------- , (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described, application is made in compliance with County Ordinance No. 549. : .. - E/7 JOB ADDRESS AND LOCATION-- �- - f' ---� � .f Phone------------------------------------ ------- T ------ •--- ----------- Owner's Name --- ----••----•--- ------------------------------------------- Address--------- -•------- --------------•-------- ' - � ` Contrac _1* � ----- - - - - ---------------------------- ------•-------- Phone_------•-•-----•--•-----.. I tor' -Name------------- - mss " `---- - -0 Other t Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Installation will serve: Residence ��Apartment House ❑ - `- •-------- .___`,Number of bedrooms _ - Number of baths "-_ Lot size .� --"-- Number of living units: � ^% , Water Supply: Public system F-1Commnity system ElPrivate epth to Water Table ft. Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �lardpan ❑ Character of soil to a depth of 3 fe�t:�Sand ❑ ❑ FHA/VA: Yes per' No ❑ l , Previous Application Made: (If yes,date - ---..--.- -1 No � New Construe#ion: Yes 'No 1 ll TYPE OF INSTALLATION AND SPECIFICATIONS: i r i' [No septic tank or cesspool permi#ted -if public sewer is available within 200 feet.) , �'% - Septic Tank: Distance from nearest well-v, Distance from a W �_ Li u id de th_- �� P Y No. of compartments---rd�- ------------- -- Sizer ��`f q i � � Distance to nearest l02 it linef� Disposal Field: Distance from nearest weli.WZIP-------Distance from foundation_ Width of trent Len Length of each line-_ �-------- - ---- -- --------------------------- Number of lines---• -------Z-"-- g i/ De th of filter m al___ -- --- otal length__ :. ------------------------ W ----=--------- Type of filter material - - p 1 `1 __.___Distance to nearest lot line_�Q- Distan e frw"fou. tion/ 1, Seepage Pit: Distance to nearest well-_/e --- ', ,o Size: Diameter-- ----- ----------- p � Number of pits---- -------- _-Lining materi __ --"- -- -- �.: ' Cesspool: Distance from,�neares l ------ Dista ce fro oundation..--- ---Liqu'+d Capacity-- .------------------------gals. r Size: Diameter----------------- ------ Depth- - I Distance from jrwell------------------------ -------- ------- ---Distance from nearest building-----_--- --------------- ----- ------ ---� Privy: -- ---- -------- --------- - -- ------ -- ------- ----------------- i ❑ Distance -to nearest lot,line.= ----° ------ ----- --- ---- -- --- ----- -- -------�--- - -- - ' , +�. Remodeling and/or repairing (describe:__.------- a --------------------------------------- E _________________,M1ti_______._____-_________-_______-_._____________ _ _.__---____.__---___-__.--__._ l -------------------------------------------------------i------------------'--i------.y"-`- -.---------------------- - --------------------------------------------- - --- ---------------------------------------------- -hat - ----- --------------------------------------------------------- ---- in - cco 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 re latiansti a Joaquin Local Health District. v ---- -----------------------------------� r Contractor) or) .(Signed) -- -- --------- ; of. plan, showing size of lot, location of systemFit o we11s, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY l - - ------ ----------------------------- DATE------ �F I---'-------------- APPLICATION ACCEPTED BY { ll- ,. DATE------------------- --- REVIEWEDBY------ ------------------------ -------- - ----------- ------- , ------ ------ -- ---- DATE-------------- BUILDING PERMIT ISSUED-------------------------------------------------- Alterations and/or recommen attons:---___..__--_--"--------------- -------------- -------- ------------------ . ------ ---------------- Date-------- - --- � ------: - 1 FINAL INSPECTION BY:.----- = -------- -------------- ----------------- i I , SAN JOAQUIN LOCAL HEALTH DISTRICT A 1Sycamore Street 205 West 9th Street 1601 E.Haalion Ave. 300 West Oak Street 24 ° Manteca,California Tracy,California Stockton,California � Lodi,California �, • ' a F.P.CC.