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APPLICATION FOR ...,NITATION PERMIT Permit No. ...0___a"j. _, (Complete in Duplicate) yV Date Issued _ _.___l__-_..,�___.____ Apphca ion 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 ith County Ordinance No. 549. r 31 JOB ADDRESS Aj� LOCATIO -- ,- �--- Owner's Name------Y ----- - - Phone '( Q!- -_1_-1 Q. Address-•--••- -........ Di__ -• ---------------•----•--••----------------------------------------------- -----------•Contractor's Name__ zk U--- ------------ -------------- --------- ----------------------------------------------------- Phor -_— __._3-' .� Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Yotef Q Other ❑ i Number of living units: __I____ Number of bedrooms _-'Z_ Number of baths __j____ Lot size _/,S_._. __________________ Water Supply: Public system [Community system ElPrivate F] Depth to Water Table _ ___ _ ft. Character of soil to a depth of 3 feet: Sand Gravel [ISandy Loam ElClay Loam [3Clay E] Adobe P-""Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes Fkr'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from, nearest well_________________Distance from foundation--------------------Material---------------------------------------------- --- No. of compartments-------:_--------- ---Size-------------------------------Liquid depth--------------------------Capacity-------------------- , Disposal Fiel Distance from nearest well_ _ Distance from foundation--------------------Distance to nearest lot line_________________ Number of lines-----------•-----------------------Length of each line-------•---------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage it: Distance to nearest well.Ant.&JU-_ Distance from foundation_____ Distance to nearest lot lin Number of pits...._f-----_----------Lining materiaL.�__._.Size: Di_ er____ ....__.__..Depth-----Z.4-_--_-_______.____._ Cesspool: Distance from nearest well-----------------Distance from foundation______--------------Lining material_______-....__.________..____________ ❑ Size: Diameter------------ -------------------------Depth----------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well-------------------------------------------.____Distance from nearest building ❑ Distance fo nearest lot line.----- --- --- ------------------------------------------------------------------------•----- ----------------------------- - _ e---,-,--�--.---- Remdfng. d or re airin_g (describe): -------------- ------ --- -- 9=- -------- ` �I -----------------------------'----------'qJ-"-`------------ -----------'--------------'----- r----------- ------------......----------------------- -----=�--j--------"-`------•-----------------•-------------------�- 1J V - �J ------------------------•---------- ----------------k---- •---- ---------------------- , I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordina to laws, and rules and regulations of the San Joaquin Local Health District. (Signe ._ _ {Owner and/or Contractor] $y:------------ --------- ------ �!-?� °`''�--� - ------------ (Title) i ---------------- (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---- - - DATE- ------------------------------------------------- -- REVIEWEDBY-------------------------------_: - ----------------------------------------- ------ DATE---t;z.-------------------------------------------------- BUILDING PERMIT ISSUED----------- DATI Alterations and/or recommendations: - -------•--•----••---------------------------------- . � p w - - - ------ ------------------------------------------- ------------- - ----------- 4___�SPECTION S------------------------------------- Date ---------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 -5q 6 nTw...