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411, 41m, �_ Psrmit No, � F N R A ,.CJI , [Corn ieteeirn late Issued ------.----- _-. Applica+ion is hereby made to the Saiz oa ui o al f le61t1 D,spjk.f for_ permit .c -eoizst fend Inst 1F a work herein described. This application is made in compliance witCounty Ordinance No. S49. � r JOB ADDRESS A t- CATIA 1 -..__._ - r� -•-------------------=•------------ Owner's Name V Ph -.. - - — ------------------ ' -------•-•---`------------------------------••------- Phone Contractor's Name---- --------•- ------- ----- -------------------------- Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ �M; el Other ❑ �C. --------------------- --------------- i Number of living units: _--�_- Number of bedrooms o3.- Number f baths ___�___ Lot size_______.._ __1 _ _ Water Supply: Public system El _ Community system ❑ Private Depth to`Water Table .__"_" ft. Pp Y Character of soil to a. depth of 3 feet: y Sand E] Gravel Sandy Loa Clay Loam [:3Clay ElAdobe/Hardpan ❑ Previous Application Made: Yes F1 No New Construction: Yes ❑ { �� TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if publ'l sewer is available within 200 feet. Ma;'F' _ Septic tank: Distance from nearest wellDista c fro�m foundation-___________".___ _ ----------------------- v __ ► f No.. of compartments S, ----J_- Liquid depth Capacity �� istance from foundation!I!__j!+""__Distance to nearest lo...line_ _. Dispos Field: Distance from nearest welly_____"_"__. ; Length of each line__________" r Width of trench_"_---_, �,Cf"l-__t_ - _ ;Number of lines--------- -----[,�- ----- 9 1i""-. i c�� -- Type of filter ria _'_. `I' Depth of filter material_________ _ _______Total length--__________-__1__fJ__ ------------- mate (' Seepage Pit: "'Distance to nearest well----------------__"__-IDistance from foundation____.4___,e'.- Distance to nearest lot line ____________ Number of pits. -Lining material-----------------------Size: Diameter-------=--------------Depth------------------------------- J ❑ }r Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- mater _ ial---__""_____--- __"_________________. F-1 Cesspool: Diameter--------------------------------------Depth---------------------------- - --------------- --Liquid Capacity----------------------------gals, i Privy Distance from nearest well--`----------------------------------------------Distance from nearest building-------------------------------•---- - y:° I 'Distance to nearest lot line--- ---------- - ------------------- --------------------------------------------------•-----------------" Remodeling and/or repairing (describe)----------------------------- ---------------------------------I----------------11------------------------------------------------------------------ ------- ----------- --------------------------•--•--------------------•------------------------------------------•- -------- { --•--------------------------------•-•-.---•------------ -------------------------------- . '---•_____=_5. . -•---•-••---------------------------------------••------------------------- I hereby certify�thaf I have prepared this application and that the work will be done in accordance with San Joaquin County ! ordinances, State-laws,and rules aannd regulations of +he,San-Joaquin Local Health District. R' 1I " (Owner and/or Contract or-------- ------ ------------- --- ---------------- ned]_ i #(Sigi 47 BY:---------------------------------- ------ _ � � ------------------------------------------ {Title [Plot plan, showing size of lot, location of. ystem in relation to wells, buildings,'e+c., can 6e-placed on,reverse_side].�r FOR.DEPARTMENT USE ONLY R � APPLICATION ACCEPTED BY�-----------------------------------"--------- -- { --------------- DATE--1 -------------------------------------------------- REVIEWEDBY------------- --------------- ►---------- ---------- ----------------- DATE_. 4�� BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE 9`1 ------------------- Alterations and/or recommendations:--------------------------------------------- - -------=---------•---------------•-----•--•----•-- --------------------------------------------------------...................... -------•-----•------=---------------------------•----------------------------------------- --------"-------•--•-------•--"-----.-.--•---••-------------------------------------------- -------=----------- -------------------------- ------------------• - , ------- -- - -L-. --------- Date-----` -- { FINAL INSPECTION BY:------ --------------------------------------- SAN - SAN JOAQUIN LOCAL HEALTH DISTRICT ' t 130 South American Street t 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California - E5-9-21A ; ' Revised W-2100 _ _1