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F R OFFICE USE: L ` .. ,;a ;�. - �� , - Permit Na. 11..._..� APPLICATION FOR UNITATION PERMIT ----------------------------------------------- . (Complete in Duplicate) -Date Issued _'T6 I This Permit Expires 1 Year From Date Issued `------------- -----t`"---"-"---""------- ------------- q Application is hereby made to the San Joa uin Local Health District for a permit to construct and in all the work herein described. This application is made in compliance with County Ordinance No. 549. �l ''] JOB ADDRESS AND CATION--- ett ,�-_ B -�---- t7C Il!_A------------------------ ----------------------- Phone ,0 Owners Name------- - --��'-' ---��----- ••- --� -- - - - ------------ -- Address__ -`-�- ----- 1-- ---�--�------'�------------------------------- ------------------------------ ------------ ----•---•---------•-------------------------- Co tractor's Name---------------------------- - ------- --- --------- ------------ -------------------------------- ----------------------------------------- Phone----------------------------------- 'I Installation will serve: Residence Apartment House [ICommercial ❑ Trailer Court ❑ Mot E] Ot/er❑ yy Number of living units: -A-__ Number of bedrooms of baths ---I-_ Lot size ----S�--X--�d--- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __ f, Character of soil to a depth of 3 feet: Sand L] Gravel E] S. y Loam ❑ Clay Loam ❑ Clay ❑ Adobe El"'Hardpan F-1Previous Application Made: Ilf yes,date---------------- No New Construction: Yes L? N, El FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se;ptic..Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------------------..__.__._..._. •. Liquid depth--------------- - ----Capacity !A No. of compartmenfis------- ------ ------- --Size-------------------------------- - ----- ---------------- ----- [)4osal Field: Distance from nearest well- ._-__-.-_---Distance from foundation--------------------Distance to nearest lot line----------------- [)4osalyr Number of lines--------------------------------- Length of each line Width of trench Type of fi3ter material____ _________Depth of filter materia!_.__.__________,.__.Total length___.__..._.____-______.---_-------- ``0 Distance to nearest lot liner.__-_._..____._ Seepage +t: Distance to nearest well- 6--___Distance from foundation___�C______________ Number of pits----_----_/---------Lining material--- -- as - -Size: Diameter_-.r ?------------Depth-----m5-------------------- I� a Cosspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material __-___.-.-----.---_.__..______-..__. Size: Diameter-.---.❑ ---- ----- - -- -----Depth-------------- --------------------- ---------------Liquid Capacity----------------------------gals. - - Privy: a _ Distance from nearest well----------------- -.-----__--_--.__-------_._--.Distance from nearest building-------------------------------.---------- h ❑ Distance to nearest lot line----------_---- ------------------------------------------ Remodeling and/or repairing (describe):_____ 1 f -------W j' ---------------------- ------------------- -------------------------------- ' ------•--------------------------------------- I --------------------------------I---------------------------------------------------------------------------------------•------- -----------------------------Y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Count ordinances, State laws, and rules and re lotions o the San Joaquin Local Health District. I+ A 4 _ Own and or Contractor (Signed}---- ` '� - / I i? Title By:----------------------------- - - -------------------------- - ---- - --- ------------------ I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). +l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- --------- DATE------�----�---- -� . REVIEWEDBY-------------------------------- DATE------------•---------------------------------------------- r BUILDING PERMIT ISSUED--------------- ---- ------------------- DATE----------------------------------------- -------------- Alter ons nd/or recomm ndations: --------- ------------- --- ------------------ -------------------- ------------- ----- - --------.-------- ---------- -- ---- --------------------------- --------- 1. - - 4.V._ .1 � - --�-f--- -�- ---- �------- -------------------- - -------- ------------------- ------ r ------------------------------------------------ -------- �n ---- --- 11 FINAL INSPECTION BY:.. - .. _;t}----------------- ----- - ------------ Date- ----�>�I�Z -------- -------------- --------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haieltan Ave. 300 West Oak Street 124 Sycamore Street f 205 West 91h Street y Stockton,California Lodi,California Manteca,California Tracy,California I' F-P.C❑. EI