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K ITATION PERMIT �/eit No <br /> APPLICATION FOR SAN <br /> (Complete in Duplicate) Date Issued .-. - ?------ <br /> described. <br /> p rmif-f-o-tonstru T­t <br /> Application is hereby made to the Son Joaquin Local Health District for a ' e construct and the work herein <br /> This application ma n mpliance with C un y Ordinance No. 549. <br /> r,'S F';A? <br /> ew----*�_e ------- <br /> JOBADDRES -- --- -- --------------------------------- ------------------------ Phone----------------- --- --- <br /> 's Name------- ---- ----- - - - ---------------- <br /> Owner - --------------------- ----------------------------- <br /> ------- ---- ------------ <br /> Address_---------- ----------e I <br /> �Z � Phone---------------------------------- <br /> Contractor's Name- Other E] <br /> Residence Apartment House El Commercial Trailer Court 0 Motel El <br /> Installation will serve: -------------------- <br /> Number of living units: /--.-- Number of bedrooms--- Number of baths A- --- Lot size <br /> Community system El Private [] Depth to Water Table 5o rft. <br /> Water Supply: Public system F-I <br /> F1 Clay Loam El Clay E] Adobe 2��ardpan 0 <br /> Character of soil to a depth of 3 feet: Sand El Gravel T7 Sandy Loam /VA; Yes E] No <br /> Previous Application Made: Yes F1 No jq"New Construction: Yes y�� No F1 FHA <br /> ❑ <br /> TYPE OF INSTALLATION AND'SPECIFICATIONS: tin 200 feet.) <br /> (No septic tank or`cesspool permitted if public sewer is available within <br /> Distance from fou dat;on--- ---------------------Material-- ----- -- - ----------- <br /> Septic Tank: Distance from nearest well__ <br /> -------- --------Capa -i <br /> Size ---Liquid depfh- _0 <br /> t f line-- <br /> No. of compartments--__ <br /> Distance from near Ias -Distance from foundation Ll. ----------Distance to nearest __2K_ <br /> Disposal Field: . OoP-Length of each line----- -----width of trench---;�,, I------------ <br /> Number of lines------- --- ry <br /> --------- -Total length---/-----`--------------------- <br /> e <br /> �!--------To <br /> Type of filter material - ----- Or <br /> Depth of filter material <br /> ...... N-1 <br /> 4 Distance �rom foujPdaf1on__j_V_1ncto nearest lot <br /> & Dista ----.DistaX <br /> Seepage Pit: Distance to .nearest we ----- eptk------- <br /> r 4.;�' its-----1�2------------Lining material <br /> Number of p k.Size; Diameter---9S__1- -----D <br /> ance from foundation-------- -----------Lining material--------------------------------- <br /> Ce,55POGI; Distance frorn nearest well-----------------Dist ......Liquid Capacify_--------------------------gals. <br /> Size. Diameter------- --------------------:----------Depfh----------------------------------- ----------- <br /> El .1 . Distance from nearest building---------------------------------------- <br /> Privy: D�stance from nearesf:well------ ------ --------------------------------------------------------- --------------------- ---------------------------------------- <br /> -------- <br /> Distance to nearest lot line_--------------------- ----------- ------------- <br /> ----- --- --- ----- - --------- ----­--- ------- <br /> ­----- <br /> - - ---------------------- <br /> Remodeling and/or repairing (describe):------ - --- - ------ ---------------------------- ---------------------------------- <br /> --------------------------- ------------------------------------------------------ ------------------------ ----------------- ------------------------------------------------------I-------------- -------------- <br /> ------------------------------ <br /> ---------------- <br /> ----------------------------------------------------------------------------- ---------------------------------------- ---------------------------------- <br /> ----------------------------------------------- <br /> --------------------------------------------------------------I-------d this------ _application- and that the work will be done in accordance with San Joaquin County <br /> I hereby certify fha+ I have prepare <br /> ordinances. State laws, and rules and regulations of the San Joaquin�L cat Health Distr.ic.f. <br /> Contractorl <br /> ----------- <br /> ------------- <br /> (Signed)------- ------- ------ ------------------------- <br /> -------------(Tit le)..... <br /> By:----•--------------------------- ----------- <br /> buildAon reverse de). <br /> (plot plan, showing size of I , location-of'system in relation to wells, ings, etc., can be place <br /> FOR DEPARTMENT USE ONLY <br /> DATE-------<,--' - --- ------------------------------- <br /> APPLICATION ACCEPTED BY--------------------- ------- --------------- ----------------•---------------------- DATE,<----------- -------------------------------------- <br /> ----------------------- <br /> ---- --------- <br /> REVIEWED BY-------------=------------------------------------ ----------- -------------__ DATE--- --------------------------- <br /> - ------------------------- <br /> Alterations <br /> PERMIT ISSUED_____________________________ ---------- ;I-r---------------------- <br /> ------------- <br /> ------------------------------------------------------------------------------------------- ------------ <br /> Alterations and/or recommendations---------------------- ----- --- <br /> ----- - --------- -------------- -- -- ---- _ C- -- --------C-------------I----------------------------I---------------------------- <br /> ------------------ . ----------------- <br /> ------- <br /> --------- <br /> - <br /> ------- ----:)----- --------------------- ----- <br /> ----------------------------- ------ ----------- ----------------------------------7--------------------------L_' � . <br /> --I------------------------ -------­ <br /> ------------------------------- <br /> ---------- ------- <br /> ------------------------------------ ------------- <br /> ----------------------------------- <br /> --- <br /> --- <br /> Date----- - ------------------------- <br /> FINAL INSPECTION BY:_ ------------ <br /> - ------- ------------------ <br /> SAN JOAQUIN-LOCAL HEALTH-DISTRICT <br /> 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> 130 South American Street Manteca, California Tracy, California <br /> Stockton, California Lodi, <br /> California <br /> di, <br /> Revisea 1.57 F-PCO. <br />