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FOR OFFICE USE: ` ------- ---------------------- -------- 3 --- --- Permit No. ---- - ,, APPLICATION FOR SA ------ ------------------ PERMIT (Complete in Duplicate) issued ------------------------- ----------- ------- - -- 1 `SJ This Permit Expires 1 Year From Date Issued 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. �j - � v , ' 1 ---------- JOB ADDRESS AND L ATION ----- � �/= - — � -- - • +C'. "/�� hone Owner's Name-------------- ---------- --- � •----_ -------------- ------•-------------- Address-- ---••_--Address__ - ` � .. ----- Phone--Ox Contractor's Name------ -•--. ------ t - -... � It / •+ t Installation will serve: Residence F Apartment House.❑- Commercial, ❑• Trailer Court ❑ Motel ❑ Other ❑ «—,t Number of living units: .....'Number of bedrooms -- �/Number of baths _- Lot size ---. Q��---X-1 Water Supply: Public system []g,ommunity system ❑ Private El Depth to Water Table -------- {}. Character of soil to a depth of 3 feet: Sand E] Gravel El Loam ❑ Clay Loam lay ❑ Adobe EI Hardpan ❑ Previous Application Made: [If yes date-- ----------------I No New Construction: Yes El No ❑AFH /VA: Yes ❑ No [ � TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool-permitted,ifLpublic sewer is available within 200 feet.)«. Septic Tank: Distance from nearest well---_------------Distance from foundation_----------------.Material_----------------------------------- --------- Size -----. ❑ No. of compartments Size--------------------------------Liquid dep}h----------------------Capacity------ ------------�- a Disposal [field: Distance from nearest well-. :-.-Distance from fouridation.__ __.Dis?ante to nearest lot line-% -_-- 1l--rJV/ Len th of each Width of #ren,�ll--_-rx Number of Ines--- /__ 9 '��. -�` i n-_� Total lengttitt _ -.30 i Type of filter. material.-- P f -- Depth of filter material-_ --- j Distance to nearest lot line---.- C----- Seepage --- + Seepage it: Distance to nearest well-.-_- -_-. Distance f foundat o _ Y -Linin material--fS441/- _ -Size: Diameter--� -y--__ F ;Depth--.--�=�------------------- on —-------------- \ c Number of pits.-------f---------- g r(�-- - 1 , •. Cesspool: Distance from nearest well-----------------Distance from foundation-------.-.-.--- _.Lining material-_---- _-_- ❑ Size: Diameter----------------- -- ----------- P Liquid Cepacify ----- ---- gals. N t•R Distar I r �- ,---------Distan 7p from nearest building--'- ',---------------------------------- 2 rom nearest well _- Privy: �; _- ❑ Distance to nearest lot line. = ------------------- - ------------------------------`•- ------------------------------------------ : a Remodeling and/or repairing(8&` 1be):7"`4_4U' --------------------------------------- ---------------------------------------------- I • --------------------------- ------------ ------------------------- ---- -------------------------------- ---- ------ ---Y'' ---------- ----------- I hereby certify that I have,prepared this application and that the work will be done in accordance w'th San Joaquin County ordinances, State laws, and rul '.and regu tions of the San Joaq r iSLI.,rie,t/.alth District. Ownf and/or Contractor) . .(Signed)-------------- (Title) , r " ------------- (Plot plan, showing size of lat'ji'oca ion of system in relation to.wells,100'Eldings, e#c., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY----- ---------------------------------------- DATE--------- ��= ---------------------- REVIEWED BY--------------------------------------------- ------------- -----------;------------- ------4--------- D ATE---------------------------------------------------------- . �"'"� � '^--'-..------ ----- ---- - DATE------------------------ ------------ -------------- BUILDING PERMIT ISSUED .g Alterations and/or recommendations.-- --..1-_ --- -- z --------•-------------------------------------------- -- .-.-.. - - --------------------- ---------------------------------------------------------- ------------------- - y f r -------------------------------------- --------------------------------------- -- -------- i ------------------------ Date..-. 1� S ----------------------------- ° FINAL INSPECTION BY:-------- / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street -' Stockton,California Lodi,California Manteca,California Tracy,California F.P.C O.