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FOR OFFICE USE: ---------------------------------- --- --------- ---- l APPLICATION FOR--S^ITA;,,,-iuN PERMIT Permit No. ------ -- ---- ------------------------------ (Complefe•in Duplicate) -� This Permit Expires 1 Year From Date Issued 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION. /D -------- 14 ------ -- --- --- ---------------------------------------3 T 3 3 Owner's Name r ` - P�one_ ------------•---- 7 c - ----------------- Address Contractor's Name-------------- ___ __.- _- ___ Phone_�Z p&rk_,�v- Installation will serve: Resi encs Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ v Number of living units: J_.___ Number of bedrooms I,--_ Number of baths_1----- Lot size -j(019 . __ ZAQ_""'___.______-_____._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table6Q_ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: (If yes,date----____________ ) NoX New Construction: Yes ❑ No 14 FHA/VA: Yes ❑ No K Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept-iciT;ank: Distance from nearest well-----------------Distance from foundation--------------------Material -------------- --------------------------------- u� �1S44t a No. of compartments-__ - -Size-------------------- ----------Liquid depth------... ....... --- Capacity----------------------- Disposal Field: Distance from nearest well_I)ME'_Distance from foundation___3_�p..__.._.Disfance to nearest lot line__/_0__ o. Number of lines0_ .. _____ _ Length of each line__49._FT Width of trench____z4_Q------------------- Type of filter materia!__ ...__Depth of filter material____ ._ f_4-Tota! length_._._ ? _ __—_______________p. Seepage Pit: Distance to near st-well_/�.�P1WC--____Distance om undation.___7-S____"Pistanre to nearest lot line_ i- � _r XNumber of pits _)_--..__.-_.Lining material-- . Size: Diameter_. -._._. __Depth.,?__,57 a__._____.. ------ Cesspool. Distance from nearest welt ________________Distance from foundation----------------- ..Lining material_._.._..._._______..____...._____.._. ❑ Size: Diameter- -- --------- ----- ----------------Depth-_----------- -- --- -----------..Liquid Capacity- --------------------------gals. Privy: Distance from nearest well...._ ------ __________________________________Distance from nearest building.._.__-___.-._.____-___________.._._._._. ❑ Distance to nearest lot line- ------ -------------------------- ----------------------- ---------------------------------------------------- ---------------------------- Remodeling and/or repairing (describe): 1 - -- -- -------- -- -- --------- �. ----------------------------- ---------- ---------------------------------------------------------------------- - ------------ I hereby certify thave prepared this application a at the work will be done in accordance with San Joaquin County ordinances, State law ,:9arules and re rations of +he S oagtirin Local Health District. (Signed)------------- - .�- -- ------------ ----------- --------- --- ----------- ------. ---------. weer and/or Contractor] ' Title - ( P BY� y �; :-. 9 (Title) reverse side]. Plot Ian, showingsize of lo+, location of system in relati to well , buildin s, etc., can be placed(An revs FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY- - DATE - REVIEWEDBY----- --------------------------------------- ---- --- ---------------------- ------ DATE---------------------------------------- ---------- BUILDING PERMIT ISSUED-------- -- ------- ------------ - ------------------ - --------------- ------ DATE---------------------------- - ------ ... Alterations and/or recommendations:__-..... ........... .. ....................... ... __. ----------- ------- +^ac. �P,� 'Vi'''i ---f--------------------------------- -- ----------------------- ------- .-.. - ---------- ----------------------- --- - - ------- - FINAL INSPECTION BY:- ----------_.VV---c..'-_°"'---V-"-------- Date---.ZY---- G-------- � - - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press _1