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FOR OFFICE USE: <br /> Cl Permit <br /> -------------------------- <br /> AP!UP'LlIATION FOR SANIf -1164 PERMIT <br /> -------- - i (Complete in Duplicate) <br /> ll�I' <br /> ------------ ---- ThisPermit Expires I Year From Date Issued Date Issued <br /> Application is hereby made t3-the San Joaquin Local Health District for a permit to const ct and install the work herein described. <br /> This application is made in compliancewithCounty Ordinance No. 549. e?-f-Z 11' <br /> JOB ADDRESS AND LOCATION...--O. ...... ------A ,----On ------ ........ <br /> Owner's Name-------d:_G, ...... .. -- ------------ . ..... --------------------------------------- ------------ ------- Phone.'J�-.D... <br /> ............... <br /> ----------- <br /> ----------------- .......O�L --------------------------------- <br /> Address--------)- - 4......ct <br /> Contractor's ............ ---------­----------------------------------------------------------------------- ........I........................ <br /> Installation will—seivai -R—esidence I@Apartment H--+ — EuT._ff_Commercial In Trailer Court ❑ Mote 1 1 0 1 #1, <br /> Number of living'4units: --j.... Number of bedrooms ---3-.Number of baths ___L___ Lot size ------------_--__------ <br /> Water Supply: Public ' stem El Community system F f 11 If � /i I I <br /> system Private N Depth to Water Table -------- t. <br /> 111, 1 If IT <br /> Character of soil to a dipth of 3 feet:I Saricl C] ❑Gravel El Sandy Loam [_1 Clay Loam E].. Clay [] Adobe®, Hardpan C] <br /> C3 <br /> Previous Applicafion Made: (If yes,date--------------------) No New Construction: Yes F A <br /> No FHA/VA- Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS -4& <br /> (No septic tank or cesspool permitted if public sewer is aiailable within 200 feet.) <br /> Distance from nearest well_.-.______------Distance from foundation________________ Material <br /> Septic Tank: --------- <br /> No. of -------- ................................ <br /> -compartments----•-------------- -----Size-------`-_,Size-------­------------------- Liquid depth--- ----------!------!. Capacjty....................... <br /> . it,� "2K" to;nearest' <br /> Disposal Field: Distance from nearest L Distance to nearest lot line... <br /> -Distance fr6F 11 <br /> Numbe� of,lines_ idih 'f trench. ..,------------------- <br /> N /----- . Length of each line---16A--__.___«_----:Width 0 ------2 <br /> filtermaterial__ <br /> Type o� filte--------Depth of filter material------- le'ngtg--------A ..p_________________..____.. <br /> Seepage <br /> .0- ---------------------- <br /> Seepage Pit: Disfaince to nearest well-)--------------------Digtance from foundation............_-------.D.-ista hce to nearest lot line----------------- <br /> El Number of pits______________'""""""" Lining: Size:-Diameter_A+=4!Ibep'th-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__---------/__Lining material-:___._:_--_______...--. I...._._._ <br /> "-------------Depth.-----•--------------------- <br /> -x ------------/------Liquid Capacity----------------------------gals. <br /> El -Size- Diameter------f------------ --------------Depth-------------------------------- <br /> Privy- Distance from nearest well----------------------`AI Distance from nearest building----i-------------------------------------- <br /> ❑ Distance to nearest lot line------------------------------------------------------------11------------_--------------------------------------------------------------- <br /> Remodelingancl/�r repairing (describe):-------------------------------------- ----------- ----------------------------------------------------------------------------------------------- <br /> ....................­..............I---------------- .........----------------------------------------------------------------­­------------------------------------------------------------------------------------ <br /> ­---------------------------- .......---------------;-I---------_-....................................------------------------------------------- .•---....--------.------ ------------------------------------ <br /> -----------------------------------------------------------I—:-------------------------I-------------------I----------------------------------------------­-------------------------I-------------------------------------- <br /> I hereby certify th;t I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws,'and rules and 'regulations of the San Joaquin Local Health District. <br /> I or and/or Contractor) <br /> (Signed)... <br /> .y------- ----------------_-------------------------------------------------------------------------(own, <br /> /1 t ` (Title)--------------------------I------------------------------------- <br /> By:........._-------------------------------------j----------- ------------------------------------*------------------ 1' <br /> (Plot plan. showing size'of lot, location of system fp,,relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --- ---------------------------------------------- DATE__//--—--- ----------- <br /> REVIEWEDBY------------ -- ---------- ----------1�------------------------------------------- DATE------ ---------------------------------------------- DATE----- - <br /> -- <br /> --- ----- <br /> BUILDING PERMIT ISSUED-------------lt----------- <br /> Alterations and/or reco'mmend'ations:___ 2= ---------- <br /> 0I <br /> ----------- -—------ --------- .... ------ <br /> ......... <br /> .... --- --- ---- <br /> ----- ---------------------------------- --------------------------------------------------------------------------------- <br /> ------------------------- <br /> FINAL INSPECTION BY:-- Qat ------------------------------------------------ <br /> ly------------------------- <br /> y---------- -------------------- ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1 <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED 8-139 RM 5-6t ATLAS <br />