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..o- FOR OFFICE USE: APPLICATION FOR V041TA"TION PERMIT PermitNo. 7...------� . -- ----------------------- -------------- -- ------------------ ---------------------- ------------ (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued __��----1.------ 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. _ JOBADDRESS AND LOATI -----------------•----I-------------------•------------------------------------------------------ Owner's Name- -___----- - its--- -------- ------- ----- Phone------------------------------------ W." -� �y� f �� "------------------------------------------------------------------------------------------------------------------------ Contractor's Name--------d�-�-- iziz -------------------- - Phone Installation will serve: Residence U?'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_._ Number of bedrooms ___/_ Number of baths _f_._ Lot size 4-4.�1��i___________________________.__._ Water Supply: Public system [ Immunity system [Private ❑ Depth to Water Table _464prt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------,........) No R 'New Construction: Yes ❑ No 6d' FHA/VA1 Yes ❑ No [1}- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well__ �____Distance from foundation___129 Mat�ia�l_� __ ___________ p� `r �{ [7�r No. of compartments-.--X-----------------Size __ ---Liquid depth---- --_----____--Capacity--r e------ Disposal Field: Distance from nearest well.. APP..Distance from found ation_!V'__.......Distance to nearest lo`line_4r_f____. Number of lines- /___.____ __________. Length of each line____7�f.____...__- -Width of trench_..Z__ ___________ P Type of filter material --- Depth of filter material___ YP - :01Total length ' l J0 �1 lin . Seepage Pit: Distance to nearest well__.a_�.�_ .�_Distance from fo ndation__y2-._____.Distance to nearest lot -. �---�_____.___ �C Number of pits------.�_''_------Lining material__ ..Size: Diameter.S�"/_...___ Cesspool: Distance from nearest-well-----------------Distance from foundatioil--------------_----..Lining material--------------._____._____.____.___. ❑ t. Size: Diameter -- Depth - - - - -------------Liquid Capacity gals. Privy- Distance from nearest well___---_------------------------------____--------Distance from nearest building-----------------____________---_._._____- ❑ Distance to nearest lot lire---------------------------------------------------------------------- ---------------------------------------------------- ---------------- . -- Remode4ing and/or repairing (describe):-------------64 ------------ ---------- -----------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------- -------------------------------- ---------------------------------------------------------------------•----------------•---------------- ---------------------------------------------------------------------------- - - 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 o the San Joaquin Local Health District. (Signed) - --- -- ---- ----�6,flldiings,�,fc., ---------------------------- Contractor] B ------------------------------------------------- --- -----------{Title] " /�/" �-..^- ----- -- ......--------..----- (Plot plan, showing size of lot, location of system in r ion to wells, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•---------- .._ c-s- ------------------------------ DATE------. -------------------- REVIEWED .• - ---------------- REVIEWEDBY----------------------------------------------- ------------------ ---------- ------------------------------------ --------- DATE------------- -------------------------------------- s BUILDINGPERMIT ISSUED------------- ----------------- ------------------------------------------- DATE-------------------------- -- ------------------------------ ? ' } --- - - = Alterations and/or recommendations:.___-_ .__�__ _._6...!............._ __ f _________Cj-__� �_..-----------------� lt _________________.___________. ________________________________-_._______.__________________________I---------- ------------ ----------_------------------------------------------------------------------------------------------.-------------------------------------------.--------------------------------------------------------------------------- ----------------- ---------- ----------________________-------------------------------------------------.-..........--------------------------------------------- FINAL INSPECTION BY:.... ......_ Date-------- ------- ......-- 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 F.P.c o.