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g t� APPLICATION PO�...,,.�ANITAI'ION PERMIT Permit No. 90.............. (Complete in Duplicate) Date Issued -------...-1-_�-1�-- Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with Count Ordinance No. 549. I JOB ADDRESS AND LOCATION.__.___ �_ _.____ __a___ � ___ _!'' L__ ____ i Name--------- ------------------------------- Address ► ---- - Phon " .. -- ----------- __. -------------------- Owner's ._ Address------•-----------. -- Contractor's Name � tti - �--------�-------------------------------------------------•-- �-'----------------•------- Phone_l�+'t1__5!3_`9.i1�r c Installation will serve: Residence M-<partment-House ❑ Commercial [) Trailer Court ❑ Motel ❑ Other ❑ f Number of living units. __(----- Number of bedrooms -:Zn- Number of baths -----�__ Lot size ____ . 0---y(-/S 4_ -------_____________________ Water Supply: Public system W-6'o—ty system WEPrivate [Depth to Water Table _ _.____ ft. Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2-"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well-- --------------Distance from foundation--------------------Material------.-----------____..___.___-----..__________. No. of compartments_-- ----------- ----- -- Size--•---------------------•� ---------------------------Liquid depth---------------- ---------Capacity---------- ------ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-_____._____-_--- Number of lines-----------•-----------------------Length of each line----------------------------.-.Width of french-----------_-----------------_------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ I r j Seepage Pit: Distance to nearest well---I_ __ -_Distance from foundation _._ Distance to nearest lot I _.._________ Baer' s3 Dumber of pits_._.►-----------------Lining mate ria l_�S-�C. —--------Size: Diameter-----------------------Depth.----- - Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material-----------------------_-___________- ❑ Size: Diameter- I-----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_-----------------------_______________Distance from nearest building____._.____________._-___________.__._._. ❑ Distance to nearest lot line----------------------------- ----------------------------------------------------•---- . Remodeling and/or repairing (describe):____- _ ' 7 __.__ 'k _._ __4? ____ ------ I --- -------- ---------- 1 ------------------•---------•---------.-••---------------------------------------------------------------------- ------------ -��-�, I ' 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)_..�-�"___ ___I-:.. ----------(Owner and/or Contractor) Y Nj----'��`" -------------- ---------------(Plot plan, showing si of lot, location of system in relation to wells, buildings, e+c., can be placed on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- - - --- --------- - -- •---•------- DATE-------------------------------- ------- REVIEWED BY------ - - O.�j - DATE ----------------- -- ,-a BUILDING PERMIT ISSUED------------- { -- .....- --- DATE------ ---------------•- ---------------------------- Al+erations and/or recommendations: ------------------------------------------ - -------- -- --- -----------_--..-------------------•-•-----------------------.-------- -----•-----------`��--�------�-�-----------•- --------------------- `-- -- -�'---- �' --------'----------------------------=_------ ------------------------------- ---------- ---- ----------------- •---------•------------- OJ 6 FINAL INSPECTION BY: - - ----- ---- -- ----- ------_1-.-- --- ` Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americ-an Stree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Straet f Stockton, California ' f Lodi, California Manteca, California Tracy, California ' • ES-9-2M I--A-- 12-5A a