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ov APPLICATION EOR ITATION PERMIT h Permit No. . .....>!7Q._.. k; Y Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instali the work herein described. This apph ' made " cam lianc w• h ounty Ordinance No. 549. � L, _ JOB A D /SIAND L ATION- = .l } ----Owner's Name-------- ---- - ---------- --•------ ----- ----- Phon.e------------------------ 1s Address __ - i --- Contractor's Name----------------- f - --------------------------------------•---------- ------------------------ Phone---------------------------------- Installation will serve: Residence 92� Apartment Mouse ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: _-/-- Number of bedrooms J_ Number of baths _A— Lot size _ _ :_---------------------- e I Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No REr New Construction: Yes W�'No ❑ FHA/VA: Yes &--T�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.tank or'cesspool permitted if public sewer is available within 200 feet.) ` l n Septic Tank: Distance from nearest we ___ �_____Distanc from cundation---![�`---------- Material----e- . ___ _ ___ y No. of compartments_-- -----------------Size Yj0_. __K_YpLiquid depth--�� - ---------Capacify--.ems-!? i , { Disposal Field: Distance from nearest well _______.Distance from foundati n--,ZA9--------Distance to nearest lot line.._-.-_- r Number of lines-------- _____________-_ Length of each line_____ w�"_.-----------Width of trench.-_;2------r-------.._-__---_- ti Type of filter material_A�_ `-Depth of filter material----fr-sr-----Total length_____ _ _`------------------ Seepage Pit: Distance to nearest well-._/OP------Distance from f dation--�4------.Distance to nearest lot i Number of P;fs_.-. -_ ________.Liningmaterial_ __ .Size: Diameter__�u�_ c------,Depth----Aa$-— Cesspool: � ! Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- I ❑ Size: Diameter--------------------- ---------------Dept h:----------------------------------------------------Liquid Capacity----------------------------gals. } Privy: Distance from nearest well------------------------------------------------- from nearest building.________-.--_---------_______._______._ ❑ Distance to nearest lot line ------ ------------- ----- Remodeling and/or repairing (describe): /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 andre ulations of the, San Joaquin Local Health District. Z(Signed)--------- - --------'�`G�------- ----------------------------(Owner and/or Contractor) By:-----------------------•----•- '-------------------------------------------(Title)--------------------- (Plot plan, showing size of lo7tionstem in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- Fj - - - - " `�' - DATE = 3 REVIEWEDBY--------------------- - '=---- ------- -- --- --- --------------------------------------------------------------------- DATE.------------------------------- BUILDING'PERMIT ISSUED------•--------------------•------------- ------------------------------------ ----------------- DATE------------------------------------------------ 0AIter m --------------------------------------------------------------'ri -- - - - -- - -- .. _... rJ,-------A�✓----- o 77- , _eC71 �-nl----4zf -41ACA'-- i•�l �7x. -----------------------------------------------------------------------------------------------------------------=----------------------------------------------------------------------------•--------------•-•--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- a FINAL- INSPECTION BY:_... ._ _ - _.: .. _ Date _.tS . �► „ 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-9-2M , Revised 1.57 FY.CO.