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iv,*-*,--,-*-,---I.............................- A�IJCATION FOR SA ', NITATION PEi;. ..T Permit - � . ... (Complete in Duplicate) ` y - This Permit Expires 1 Year From Date Issued Application is hereb made to the San Joaquin Local Health District for a permit to const Date Issued This application is made'in compliance with Countystall the w Ordinance No. 549. a ork herein descr'bed. C JOB ADDRESS AND LOCATION_.. F Owner's Name.-.-- i ame.-.-- Address-__.."y �. .. •J ---- - Ph Name _ � • __,a�e� d ' ' -_...._.— jora -----.__- , -------- . ....._...-•-•---_...Contractor's Installation will serve: Residence A Phone----_----------------- Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms-Aft_ Number of baths f �I _.1_-_ Lot size Supply: Public system _.. Community s ..................... tY Y stem ❑ Private ❑ Depth to Water Table _t!t. . ft. Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ i Clay Loam �) Clay❑ Adobe❑ Hardpan E) FPrevious Application Made: (if yes dote___________________•) No [F New Construction: Yes J$ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within X00 feet.) • ±t Septic Tank:, Distance from nearest well.__.�8 t .-__._Distan from foundation-10! No. of compo _.-•-...Material----•--•------------- rfinents -- ' -�----•--•---•Size t Q.__�',f.__._.Liquid depth-•--•-�_ Capacity / oro Disposal Field: Distance from nearest welj.SA. p ty--- ""--'- Distance from foundation_._ 0 .........Distance to nearest lot line_S_�.......... Number of lines.___.__. .__ - Length of each line--- _S ._{_..___Width of trench.-1--t/r_•------- i Type of filter materia! ___..- ,"'�e1{} of filter material_:r m.�.. � .......Total length _.. a.__..:.-------•------------� Seepage Pit: Distance to nearest well____-_.---` Distan<e from foundationj-•i ` f ? "'_' _...,__.Distance to nearest lot line----- -------- ri ❑ Number of Pits---_------------;....;Linin material ) ' g' `•---....Size: Diameter.----------------------Dept ................. Cesspool: Distance from nearest w ll_: Dce from m fox-=--- _ stanundation_---___-i_.____.tinin material-------- 0 Size: Diameter.__.___ _...._ Depth....................................... ..._........................ t .- • '.:Liquid Capacity-•........................ als. , ri Privy: Distance from nearest wt;ll_____..'._________..__ ' g •___________________-_-.-Distance fr nearest building___.. ❑ Distance to nearest lot line............ . - y l...4 _ --_-� _ Remodeling and/or repairing ( oil ... ..� / ------- ---------- -------------- .......................-......--•- I .................•- - _....__...__._._.. _...._...... .___— - -. __.._.__._...—---------------—.......-.............--............ _.......................... 1ri I hereby certify that I have prepared this application and that.the work will be done in accordance with tan Joaquin Cour ordinances, State laws, and rules and regulations of the San Joaquin Local Health fi' ? q lth District, ------------------------------------------------(Owner and/or Contractor) -_---------—-----------------------------------------------------------------(Title)---------- ...... (Plot plan,showing sne of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... l.".11_.___. _ "•---------.------=------•---- DATE_.._ -- -------------------------------------- REVIEWED REVIEWED BY-___--_-_-- ------ .................................... DATE--•--•_.....-- BUILDING PERMIT ISSUED.___--__-- - DATE..............BUILDING .................. ----------_ .__._...._. - - - ---------- - __ DATE------•-•------ - -- ---•-_.._ Alterations and/or recommendations:----------------------- ---- _................................... . ..........• .. ........................................................... ..............................................-............... --------............�......................................_..................--------•-•-•. -•---•-•--•-. ..................----- •--"---• FINAL INSP BY:.rd�'' R` ................................. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street s 124 5 cainore Slmet y. • 'Stoddan,CaliforniaClifLodi,CaliforniaalManteco,California 205 West 9th Street Tracy,California _ /