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116 y APPLICATION FOR ,-,NITATION PERMIT Permit No. ____�_ _-./ . +� (Complete in Duplicated ", Date Issued _--y- � application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Or4Lnance No. 549. J JOB ADDRESS AND LO TION. _/A ,G�. -t22- ---- --- Owner's -Owners Name r Vfes/ --------------------------- ---------------------------------- Phone- Address ... -------- -------------- ------ -- - -------------------------- - --•-------•----- --- =---------------------- Contractor's Name---------- ------- _ �-- �Phone - --�� Installation will serve: Residence Apartm House ❑ C mercial- E] Trailer Court ❑ Motel Other El Number of living units: ____--- Number of bedrooms,2--- Number of baths __j___ Lot size _ -5-�-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.��ft. Character of soil to a depth of 3 fele+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑' No New Construction: Yes No E] FHA/VA: Yes ❑ N A TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic +ank or'cesspool permitted if public sewer is available within 200 feet.) SepTank: Distance from nearest well_________________Distance from foundation-------------------Material__________.__-.__-___-_-______.___-_______.___. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------- ---- Dispos Field: } Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line_______--_--_____ ` Number of lines--------------- ------------------Length of each line------------------------------Width of trench-----------------------------_----- Type of filter material-------------------------Depth of filter material----------------------Total length------------------------------------------ Seepage ____________-_-__---_-._-______-______- See a e Pit: Distance to nearest well ---_Distance-from unclation� _________. ___ p g _ _� _ Dista to nearest I li �` ------ Size- _ Number of its__..__- /_- p __________Lining materia Size: iamet - Depth _-__ I +,Cesspool: Distance from nearest well-----------------Distance from foundation------_--- -.Lining material---------------------- _. --------___. ❑ Size: Diameter----------- ---------=•. - -..Depth-------- ------------------------- -----------------Liquid-Capacity---- .- ----------- --- I- Privy: Distance from nearest well_______________________________ ------------Distance from nearest building-_______--_- ___:_. ....... I ! ❑ Distance to nearest lot line---------------------------------- ------------------ --------- /em g rrd r repairing (describe):__-- - -- - , —� - � ---------- / �--------•-----•-------•---------------------- ----- ---------- ----------- ------- ------------------------------------------------------------------- ----------------•-------------------- ----- k k _.. -------------------------------- hereby certify +hat I have prepared this a -lication and that he work will be done in accordance with San Joaquin County ordinances, State I and es and reg No the .Uoaq6iin Lo Al Health Distr" (Signed) ' --� ------ - ----- r--- -- --- - --------�---- --(Owner an or Contractorl, By:----------------4:.. - --_--------------------------------------- --------------------------------------------LTi+le) •--- y (Plot plan, showing s' a of lot, location of system in relation +o wells, buildings, etc., can be plat d on reverse s' e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------t---- --------------------Q-------------------------------------------------------------- DATE REVIEWEDBY---------------------------------- F -- -------- ----------------------------------•------------------------ DATE------------------------------------ BUILDING PERMIT ISSUED--------------------- --------------------------------------------------------------------- DATE Alterations and/or recommendations:----_:-- _---- - ----------------------------------------------------------------------- -_ --------------_5"'�fJ = -----------QlT- s�- -„ f/�! -------- -7------- ��-Gi _ �" „� ..--�x---••------ -------------------------------------------------- -FT---------7-44--l-0--------�-----7,3 ----------- N4-i- -P _Y ----------- ----------- T----- ----------------sr--- ---- = - . FINAL INSPECTION BY ------_------ ---- -,------`------- Date-----------(412....� - - --- --- ---- • _J L.� AN JOAQUIN LOCAL HEALTH DISTRICT we 4 13 South American 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California , Manteca, California Tracy, California t . .. s ES--9---2M , Revised 1.57 F.P.CO,