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OR OFFICE USE:. .7 V ------ Ald............... APPLICATION FOR SANLION PERMIT Permit -- -- ---------------- -- --------------- -----------1--- (Complete in DuJJ P)icafe) Date Issued .............................................. This Permit Expires 1 Year From Date Issued . ..... Application is hereby made'jfo the San Joaquin Local Health District f r a permit to construct and instal'.the work herein described. This application is made in compliance with County Ordin nee Na. 5 with County y Cj JOB ADDRESS AND LOCATIO /,50_4 ------------------------ -------------------------- Owner's Name-------- Phone---------------- .................. Address..-- ................. .... ...... Contractor's Name-- - --- --------------------------------------- ---------------------------- Phone-----•-----------------••------•-- Installation hone----------------------------------- Installation will serve: Residence W"Apartment House Lj Commercial [:] Trailer Court ❑ Moiel L] Other L] Number of livinc j units: _/--- Number of bedrooms __/__ Numberofbaths ./... Lot size ----------------------- Water Supply: Public syst6rn Ll Community system_C] Private to 8-� Depth to Water Table 4*7 ft. Character of soil to a depth of•3 foot: Sand El Gravel [-] Sandy Loam [] Clay Loam 0 Clay E] Adobe 93"Hardpan El Previous Application Made: (If yes,date- --------- I No RRNewk_onstruction: Yes E] No R4- FHA/VA: Yes Ej No Q_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available; within 200 feet.) Septic Tank: Distance from neares-1we'l-%, Distance fr I foundation. o0v_ M a t e�a 1,04�;e le" ---------- L41_� No, of compartments.._!__.Size Al_lquicl ....... .-Capacity.. Disposal Field: Distance' from nearest well-A-0.-D.sfance from'foundation.... ........Distance to nearest lot linelze)..... Number:loi lines....... --- ------- Length of eac line---;r0-------------------Width of trend--,------- ------ -- Type f filter material/ --- 11 000V- - ;w 0-1� I/ - -_ epth of filter material---ZR / Total length------;Or_--------------------------- Seepage Pit: Distance. to nearest well--- ...Distance f orrilfou dafion...'�29--_-_.Distance to nearest lot Iine..6-P...... Lining material....&,k_, .........I...Dept h..c;.)S..... Ug;--i NurnLeAof pits...-_-1_--------------L; ...Size: Diameter-33.140 Cesspool: 4DIStdnce from nearest well........:____Di5fance fromfoundation--------------------Lining .......................... 1P I El Size: Diameter--------------------------------------De th--------------I-------------------------------------Liquid Capacity------------------ --------gals. nc Distae from nearest welt________I-------------------------- Privy-. . _______Distance from nearest building.__--_-___- _-.__--__-- .................. Ja— 171 Distance to-nearesf:. ------------------------------------- Iot.1' - ...., --11:r------------------------------------------------------------ -------------- --- Remodeling and/or repairin .(descr-be): ------------------------........------------ I ...................... ........ ......... ...... ........---------- ............................ -------------................ .......... . --ql _- -------------------------------------------------------:------------------------------- -------------------------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------------------------------------------- ------------------------------ -------------------------------------------------................... 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, andirulesand regulations of the San Joaquin Local Health District. (Signed).............. .. .... .. .... . ........................................ Confractorl By:.----------------------------- ....... --------------- - ............ .......... -- ------------------------------ (Plot plan, showing sire;:if [of, location of system in alflion to wells, b4ildings, etc., can be placed an reverse side). it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y____ -7WZ,7 - --- ------------------------------------------------ DATE--------- ------- ---------- REVIEWEDBY------------------ dl------------------------ ---------------------------- -------- ------------------------------ DATE--------...-------------- ---------------------_ BUILDING PERMIT 155U ED ----------- DATE - --------- -- ---------- ------------- ---------------------- ---------- ... . ..... - ------------- ecomr d t Alterations and/or r �T -7! pda ioi Lo ........ ................... .............................. ------- ........ ....................... - - -------------- -------------------------------- ------------------------ ----------- ---------7W---- -- ---------------- ....................................... ------------------------------- ................................I——...... ................... ...... ................................-------------------------------------------------------------- ........ ..................I............ .. ............ -------------------------------------------............................ ...... ......... -------------- --------------------- ....... ......... ......................... FINAL INSPECTION BY: ------------ ---- ---- -------------------- Date..... • . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelfan Ave. 300 Wesi Oak Street 124 Sycamore Street 205 West 9th sir"I Stockton,California Lodi,California Manteca,Califomin TrOCYF C01404"i*