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FOR OFFICE USE: ----=S ------------------------/1_ _ APPLICATION FORS j4k N PERMIT Permit No.�XXJ_,... --------------------------------------------------------- (Complete in Duplicate) ................ ..... This Permit Expires 1 Year From Date Issued Date Issued f C_-- 140_2_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein escribed. This application is made in compliance with,County Ordinance No. 549. "7 2_55 NSE-c. c,<-T Tr-E49-4 // ---------- ` JOB ADDRESS AND LOCATION---- -f__y__.�lJX--- Q, ..B,._. _ �v�----------- � --- T/ ----11Pa9!, ------ Owner's Name---------JN-C/ -------- --------------------------------------------- -------------------------------------------- Phone.-_143-7,0--3- . Address--------.J�------ v�A ,�_r . Q - S_7 :�-&_T'0.N--------------------- Contractor's Name-------------------&I,Ua P, --------- ------------------------------------------------------- --------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial p Trailer Court X Motel ❑ Other L❑ Number of living units: ___/_-_ Number of bedrooms ___-4 Number of baths -------- Lot size -----.-- ------------------------------ Water Supply: Public system El Community system F1 Private �pth to Water Table _X tf Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff-_`Hardpan ❑ Previous Application Made: (If yes,date--------.---- -----I No [ New Construction: Yes ER"No ❑ FHA/VA: Yes ❑ No Eg'-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tlank: Distance from nearest -------Distance/From foundation_.__�Q______..Mat ri `___� td _ __Y __. _... _ e - -- -.. i y ------- No, of compartments---------_ ------------Size--- ___ O--~f*------Liquid dpth- Sac � it - p e from nearest well Distance from foundation-----M- ------Distance to nearest lot line.... ............ Dis osa Feld: Number of lines____________ rr .. ___._______Len Length of each line______ � 4 a----------��-------Width of trench------ ------------------•-- N Type of filter material. ?_5_4�1�'1�`�Depth of filter material------Zt.__........Total length---------14-0----------------------- V) Seepage Pit: Distance to nearest wall-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits-------------.----_Lining material---------- ------ ---- Size: Diameter----------------- -----Depth..------------------------------- 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 to nearest lot 1ine-------------------------------- -------------�-------/---------®----------------------------------------------------------------------------- Remodelin an-d/or repairing describe "•__ _�._�..�fi_ E�_ =� =�----- r - -- ----------- _----------- ---- ---.` �Y `- � X`x- - --- --- ------ ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesfate laws, and rules and regulations of the San Joaquin Local Health District. { g ----_(Owner and/or Contractor} -----��-- -�-----:--: -"--- =--�-'.�__�f_�?.fes.��- --- - - -- Si (Signed _ 1 13 -- -�4 ---------------------------------------------------------------------- ----- Title--------------------------------------- ---- . .--- ----- y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- " -----------------—----------------- --------------------------- `- DATE----- � h�=�� --------- ---------------- REVIEWEDBY--------------------------------------------- -------------------- �-.-----:--------- =------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - DATE -----�,� ^ !! {- Alterations and/or recom . endat on`:.___-- -.-_-_---` -�1 -----yr , .--- _!?.d�Y___-- --------- ---------- ---------- ------- -------------7 ----------------------------------- ----------------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------ FINAL INSPECTION BY:.......... - ------- Date------ ----_`-- -- -- / . SANOAQUIN LOCAL"HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.