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FOR OFFICE USE; � "�� 3 Permit No. / __-___-___-___-_-.-. APPLICATION-"F0[ -SANJTATION PERMIT I �o' 1�---- -� f-=....:... ..... .. .(Complete in Duplicate) Date Issued __f__- -- ------.................._-.----.__..__.___.._._._.._- This Perr&it Expires 9 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549. C, -7— (90'-2—) JOB ADDRESS AND LOCATION.-. _ F,X--7„' .----�� 6f --- - ----- ------ C�-- � Owner's Name ----- Phone-----•--------------•---•- ---------------------------------------------------------------------------------------- - - Address ----------- ------------------ ----- --------- --------•-••-------------------------- ----------------------------•-------------------------------- Contractor's [dame----- _ Phone -------------------------------------------------•----------------------------- Installation will serve: Resid6nce;24-'Apartment House ❑ Commercial -❑ Trailer-Court.❑ -Motel-E] Other ❑ Number of living units: _ ___ Number-of-bedrooms Number of-baths Lot-size.___L!2. ' _ �. ---------------------- ft.Water Supply: Pub€ic's stem Community,system ❑ Private e th to Water Table •-...... Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ ' Adobe ❑ Hardpan Previous Application Mader (If yes,date._----._------------) No Z�' New Construction: Yes �No ❑ FHA/VA: Yes ❑� No 9;-.— TYPE OF INSTALLATION AND SPECIFICATIONS: „ ' ,.. (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we __t$.F9__Dista�er-om foun :a_ton_- � ----------_Nla �I--_ _.__._____- Nd. of compartments---. --------------- Size- f`-&Q_-d__Liquid depth _ Capacity.. ------ Disposal Field: Distance from nearest welL�t2 __Distance-from'foundation__= 3 _-_ ----Distance to nearest lot line------- _ _._ Number of lines---------- Length of each line____lw�___ �)---_-Width of french.-,Z------------------------� V) /I----------- moi, Type of filter material_ /� Depth of filter material___!______'-----Total length___ ____'-r _._ Seepage Fit: Distance to nearest well-_19Q��_.____Distance from foundation___ _.___ Distance to nearest lot Number of its.____ 1❑I p �-------------Lining material --��',/ -Size: Diameter------ -----..,._...__..De ------ - - -- -__ __1 Cesspool: Distancedrom nearest weil__.___f___._____-Distance from foundation____________________Lining mate�iaL_..___.--.____________._____--_____. ❑ Size:�Dlafnieter----------------------------------------Dept h---------------------------------- -------------`-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------------Distance,.from-nearest building------------------------------------------� Distance to nearest lot iine----------------------------- ----- ---------- -- ------- ------------------------------------------------------- Remodeling and/or repairinL'ig (describe):----------- -. _ ._. - .. 0 ---------- -`-" -------------- ----•----•---------------- - ----- ---- ------- ------------------ -------------------------------------- `----------------- ----------------------------------------------------•-------------•-•------ ----------------------------------------- --------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. ' (Signed)---------------------0.10I r� --- ---- --- ---- ---------------- -------------------------(CWmter-armill,/,or Contractor) m By: __(Title)._ I $ ' __... --------- ��'I (Plot plan, showing size/of lot, location.of system in tion.to wels, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY a", - ------ DATE---- = f `7=---------- ) REVIEWEDBY ------------ --------------- -------- - ---- - ------------ --------------------------------------------- DATE----------------------------------------- ------------------ BUILDING PERMIT ISSUED------------------------------ _ ------ DATE---------- -- ---------- Alterations and/or recommendations:-- .� � �A' /�,�, /L�rr� r/ ----------------------•---------- ------------------ --------------------- ----------- ------ ----------------------------------------------------------------------------- -------------- ----------------- --------------------------------------=-------------------------------•------------------------•-- = ...... ------ -------- ----------------------------------------------------------------------------------- FINAL INSPECTION BY:. :":..a. .----- C �rt��- ------ Date-...------� �� f =----------------------------- , SAN,,JOAQUIN LOCAL HEALTH DISTRICT t 1. 1601 E.Naaellon"Ave. 300 West Oak Street Q, 1.14 Sycamore Street 205 West 9th Street e a Lodi,Clifornia `Mantca,California. ��. Stockton,California � � Tracy,California V1 + t CS 9 REVISED 8.59 3M 3-'63 E.P.CD. i f•