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�'l�`f ----------- 0;\U 'rar�wt�vt;��,i S�-pz� --- ----------------�1-----------------------------•---- APPLICATION Felt SA IA �P�11tMI I Permit No. .4 t-' (Complete in Duplicate) ----- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AN LOCATION...__ \\ /` Owner's Name ` Phone 11n- A� Address1Z.3*-----• _ �)� � • -------------------- -•_........._..-- Contractor's Name .-.--1•�---- --..------ ` �-'Q'q. -. -------•-----_............. Phone.fu4..�-'1 ../�°.� Installation will serve: Residence Apartment House EL Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: A_- Number of bedrooms . Number of baths j_____ Lot size __-.q �x-_1C..1!�i'� _-_1C-l!� Water Supply: Public system ❑ Community system ❑ Private 2-Depth to Water Table -a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( 'Hardpan ❑ Previous Application Made: lif yes,date--------------------I No ❑v-''New Construction: Yes ERNo p FHA/VA: Yes ❑ No [Cy TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Sep�isposall ic Tnk: Distance from nearest well-----------------Distance from foundation-------------------.Material--_____---_____._._.--_._...___••••••••-••--•-_-• No. of compartments----------------•--------Size-----•--------------------------Liquid depth-------------- ------ --Capacity �d: Distance from nearest well_________________Distance from foundation-______..__..--____Distance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of trench......-----_-...- _ Type o alter material._•----------------------Depth of filter material----------------------.Total length_.......................----•-------•--.-- r Seepage Pit: Distance to nearest well______'___f"------Distance from foundation....OQ �...•_..Distance to nearest lot line..,_...__ Number of pits------- -------------Uning material--- . _...--- ----.Size: Qiameter-__--_6- ---_---.._Depth.------t.Q------_•-------_-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------._...._ El Size: Diameter-----------------------------------•-Depth---•----------------------------- ------.._Liquid Capacity----------•--------------...gals. Privy: Distance from nearest well_________________________________________ ____--Distance from nearest building_-_______--._______-_. Distance to nearest lot line Remodeli and/or repairing fdescribe)______________ -------------- t`�'"-'-�"�__•-.• C.____-_-_ _ r •---------••-•-------- ---------- -------------•-•------• --------------------•-----------•••----------•----------------------- ..--••--••---•---------------------•-------•----•---•-------•----------•--•------•------------•------------•--------••--------- ------------•---------------------------------------•---•--------------•-------•-------------..---------------.--------••----.-----------..-_------------------------------------------------•--•------------------•-•--- 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 of the San Joaquin Local Health District. (Sied -. % ~ gn }.._. 4�._ _ ✓� - ------•-•------•------------------"_(Owner and/or Contractor) 13y.. - -----•----------------•... ------------------•..._-....(Title)--- = (Plot plan, showingsize of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). 1-4' F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE REVIEWED BY---------------•-- = QATE { - BUILDING PERMIT ISSUED — Df4TE Alterafions and/or recommendations-----------------------------------------,------------------------------- ..------- .. FINAL INSPECTION BY---- ------ ------ =-- ----------- Date 1_ -�. .�_ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Strout 205 wort 9Th Street Stockton,California Lodl,California Manteca,California Tracy,California ES 9 REVkSEo S-a9 YM 5-67 ATLAS ' }'