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• FOR OFFICE65t: <br /> ................. Permit No. <br /> APPLICATION F0k_SANITAT <br /> —,01 <br /> (Complete in Duplicate) Date issued ............ <br /> ...... ....... This Permit Expiresj Year From Date Issued <br /> ....... .........___......... qcai Health.Rh District for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin I: .. N <br /> This application is a a i co lia W t .0 <br /> I n <br /> 010 <br /> &o 549 r <br /> JOB ADDRESS ON........ ...... ........... ...... . ... . _4-&1rL9 <br /> . Phone........_ --------------- <br /> Owner's Name—_- -- ---------- ----------- ..... .... ....... ............................. <br /> Address_..._.__._ .. :-- ..-.-...... <br /> ­/-- ----- . ..... r_....-•••........_...-...... . <br /> . <br /> Phone_..;.:....._._.-------------- <br /> Contractor's Nam ­- ------ -- ..... ---- <br /> Mote! E] Other <br /> '-.�jjjj serve:,.wResidignceR!:�Apace r, House 0 Commercial ❑[j Trailer Court 0 Mo <br /> In,falliflod bedrooms .­Nwmbar p�baths-St Lot size ....... .......Z:�� <br /> Number of living units:J...Number of Y_ f <br /> C1 Community System El PrivateDepth to Water Table <br /> Water supply; Public system Grove,0 Sandy L__ Clay Loam 0 Clay 0 Adobe{Hardpan <br /> Character of soil to a depth of 3 feet: Sand 0 No E3 <br /> t Yes Q No 0 FHA/VA:Yes❑ <br /> ...............I No rj Now Con.s ruction <br /> Previous Application Made: (if Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within 200 <br /> t .........­­.............. <br /> AP Dista <br /> c fWm,fluid aflon_)A <br /> Liquid depth_. ...... ify----------------- <br /> ........ Capae <br /> nearest lot line-'s.00 <br /> -1-neptic nk: Distance from nearest well <br /> ^0 __.si. <br /> No. of compartrnenfs_..1.__...__. <br /> foundation... ...Distance to ne <br /> Field: Distance from nearest well..�TAO./_Distance from fou AL ................. <br /> Disp/o Width of trench.. A <br /> Number of lines._.------- of each <br /> ............Length. <br /> filter material... ...........�-tal iongfiri..-J-0...................... <br /> filter material........ of <br /> P/ Type of <br /> r fro foundation.-1 40 �....._Distance to nearest lot line-, -___- <br /> Seeps <br /> Pit Distance to nearest well...I.A. Distance f er......?.V'--Depth................ <br /> ......Lining maferiaI-.!S_,4/Z.j.... <br /> .Size: Diameter <br /> .......... Lining material-__-------------------------- <br /> Cesspool. Distance from nearest well..................Distance from foundation_ at <br /> ........Liquid Capacity------------------------9 s <br /> Size: Diameter..... ._..... _-Dep�th,_: <br /> i nearest buflding:,.�..�. ...... <br /> Privy- Distance from nearest well . .......... . ...........:,.'Distance fr%r_ <br /> ................ <br /> ........... <br /> _,,_.DisfanceJ .......... <br /> .......... <br /> Remodeling and/or repairing (describe)-...... .............................................................. <br /> ....................... ................ .......................... <br /> ..................... ..............­..................... <br /> ...................................................... <br /> f. <br /> ............ <br /> -- ---------*---------- --------------- ..................................................................... <br /> ...........................................­­.............................­­­..................---­­.................................­­......................................I.......... <br /> I hereby certify that I have prepared this application and that the work wili;bii dc,46 in accordance with San Joaquin County <br /> ordinances. State 1a nd rules and regulations of the San Joaquin Local Health District. <br /> I(I y..... . . ...Ly------ ­­ ...................................-.-.-..-.- <br /> . .... and/or Contractor) <br /> O <br /> r) <br /> Signed. ' ............( . .(Title):........ . ......,... .................. <br /> .. <br /> ........ <br /> By.....­­.... <br /> (plot plan,showing sae of lot,location of system in relation a wells, buildings,aft.. can be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> W ....... -------------------­- <br /> APPLICATION ACCEPTED BY- .................. DATE............---­............. ........................ <br /> REVIEWED BY................­­............ ........ ........­­.. <br /> I. .................... .............................. ...... <br /> ... <br /> .. ............ ................ <br /> BUILDING PERMIT ISSUED......­­­­* ......... ................ <br /> ir Alterations and/or recornmeridafions............_..................................................... I--- _»......-................. <br /> .......................................................................t..... <br /> ......................... ............._...........................................­­.................... <br /> ............... ............ <br /> .............I................................. ......­­­­­......................... <br /> .............. <br /> ............................................................ ...... <br /> ...................­.­..........I—. <br /> ------------- ...........:.......... ....... ................................I....................................... ........................-1.................... <br /> Date._....--. ..- ------.... ... <br /> FINAL INSPECT40N BY ....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.tisixeltoA Ave. 300-West Oak Street 124 Sycomolt Street 205 West 91h Street <br /> Lodi,tafifomia Maw.ca,CaliforAiv Tracy,California <br />