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r----- '--= '�------- ------ 1'1t r �.r�✓i ,�i vr {Complete in Duplicate) I s ---- - ------------ ------------------------ Date Issued _.____----------------------- This Permit Expires 1l 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 I escribed. This-application is made in compliance with County Ordinance No. 549. . � r ATI ------JOB ADDRESS AND - Owner's Name-------- / ._�Lf__ Phone Address----...------------- — II Contractors Name____ __________ j - ------------- -------- --- Phone �Ap ) tial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence artment House ---Z--Number Lot size _-��----------------- Number of living units: ___ ._ - Number of bedrooms- umber of baths Water Supply: Public system ❑ Community sys�tem ❑ Private ❑, Depth to Water Table&"`/ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San am ❑ Clay Loam ❑ Clay ❑ be_° Hardpan ❑ Previous Application Made: (if yes,date- --. } No New Construction: Yes ❑ No HA/VA: Yes 'll No Q/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well.----.mm.' --_-Distance from foundation----______-------_Material---.._____-_____..-.____...___.-------_________- I`0------Size--------------------------------Liquid depth------------- ----------..Capac•sty---II----- ! �� No. of compartments_______________ ,{' «� f es1-.-_ __.Distance to nearest lot line___aS._a_____ Disposal 'eld: Distance from Nearest well_-- from foundation___..._ � � Number of lines----------f -__ Length of each line------ - -- ------.Width of trench---. .--r-��------------------ �� lType of filter material_ � p—^-Depth of filter material_._.�e-______.Total length..--- Al' ______ I------------------ 'f p g "�"'v ---^ ______Distance from foundation___. ~ 1 �� Dist nce to nearest lot line____________ See a e Distance topeares�ell_- ding material... _„ Size: Number of its-__.__ Li Cesspool: Distance from nearest well-----� a .-----Distance from foundation.--------_-------___Lining material__ _ t ❑ Size: Diameter._. • -------- Depth --------------------------Liquid Capacity. - ------------ -----gals. Distance from nearest buildin 1--------------- - Privy: Distance from nearest well -- 9 1r ! ❑ Distance to nearest lot line._--L-� __ ___. N' a fRemodeling and/or repairing (describe):.-------------- 11 A� " - V+ �•----------- �I 3 ---------------- ----- ------------ ---------- -------------------- -------- ------------ 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 :of1 the San Joaquin Local Health District. - - = Title { ----(Owner and/or!Contractor) (Signed)-- • !.:. } (Plot plan, showing size of lot, location of system in'relation t ells, buildings, etc., can be placed on reverse side). a k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --- --�''- ✓ s ---------------- DATE------------ REVIEWED BY-----.-. ---- `° DATE-------- ----------------------------- BUILDING PERMIT ISSUED-----.-.----- --- ------------ DATE---- ----- Alterations and/or recommendations:-- --- f � _rr - 't .` r ' - ------ ----•- ----------- t --------•--------- ------------ --------- -•-------- -------- 11 - ----------- ------- / 'f f II FINAL INSPECTION .. --- ----- ------ � r� ------ Date. { SAN J1'O UIN LOCAL HEALTH DISTRICT 1601 E.I{a><elton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th J., f 11 Brockton,California Lodi,California Manteca,California Tracy,California