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I - ivf:Rr . -- APPLICATIO FOR SAN N PERMIT / 1 Permit No. _.f.�Z. ___ - - ------------ ------- -- (Complete in Duplicate) " This Permit Ex fres 1 Year From Date Issued 'k Date Issued ! - 7� Application is hereby made to the San Joaquin Local Health District for a permit This application is made-in-compliance with County Ordinance No. 549. to construct and instal{the work herein described. j,JOB A D ESS AND - - . : . s � . ------------ Owners Name.. } �.C—A11'1' - - = i .-'�<r_ Y� �: ... .� -- -------- --- -- --- ----- f Contractor's Name,/6.4 - -...._- Phone--------------- ----------•-----•- Installation will nerye: Residence Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other Number of living units: . Number of bedrooms _-_-Number of baths J Water Supply: Public system Lot size __._ __ _ Y ❑ Community system [] - i was M Dept TO/Water. ft. ` Character of soil to a depth of 3 feet:, Sends Gravel . ❑ Sandy foam ClLoam Clay ' Y ^❑ la > Previous Application -{lf yes,date----------- --- ❑ Y N Hardpan ❑- Adobe❑ 7) No New=Construction.;.-Yeses� s � TYPE OF INSTALLATION AND SPECIFICATIONS: ;-� `"O ` — FHA _ A:Yes ❑ _, No _ f (No septic tank or cesspool permitted if,public sewer is available withuri 20vfaw-) 'r ' Wei" I I , Septic Tank: Distance from nearest well_________________Distance 6. foundation___..__..__ Ma erial •-----•- a 1� F No. of compartments_.._....`--------Size...._-:._, --- �' -- Liquid,depth---- ------- -------- Ca Capacity ) _ Disposal Field: Distance from nearest well._.,•-Distancet_dm�foun atign__ ,��-__•,1_Dis ante to nearest lotyline.___ D . Number of lines____________ __ _ Length of each fin g �i =---- -- ------ -- ----. 7 Width of trench..---- ff---.----� . Type of filter material._._ Q�_r __Depth of filter maIda erial�"- -----------Tot l length. ..---•--•-----•---(: � Seepage Pit: Distance_ to nearest well____-- ------- ----------------Distance from foution---.._ ❑ Number of its___---------------_-Linin material_:.___-___._-"-._-_ -.Si e �{ _ ___.___.pisance to nearest lot li e_____________ p g : Diameter__._.__._ Cesspool: Depth----------- ':. . . p Distance from nearest well _________ __Distance from foundation.._-_._._" ❑ Size: Diamet -""------- Lng materiel-------•- F ga[ -----------------------------------Depth ---------- --------------------- ---------------Li liquid Ca Capacity_ Priv t � q P tY- ----------•------••------9alse. .a, .I Y�•-� bistance fro1. nearest well_______________-- Distance from nearest building"----.---"-__---_ ) ❑ Distance to nearest lot line-------------•--------------- •--••----•-- -------------------- emodeling and/Gr, (d scribe):_--__-__-_-_I•-- - -- - --- - - -- - - --- - ---- - •--•-------------•----------- -•-------•-----------------•------------------------------------ -• -------------------•-----•-------•-----------•---- ----------------•-------------------------------------------------- --- -------------- ---------------------w-------------------------------- ------•---------------•-------•----------------------•- .... is ------------------------------------------------ e -- - -----••------•-------••----------- ----------- ------ I hereby cerIfj that I have ed his application and that tgalwork will be done in accordance with San Joa uin County ordinances, Stat' . r_s, id rules: 'nd ul tion .of fhe San Joaquin Local Health District. (Signed)_.._.- _ - ------------(Owner and/&& Contractor)` --------------- -- Y� •-•---------------- ----------------------------------------------------------------------------------------(Trifle)-------- --------•-----•----------------- -------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -"------------------- REVIEWED BY ----------------------------------------------- DATE----- - -�-- -------------------- BUILDING PERMIT ISSUED------------------------ - ----------------------------------- ----------------•-- -------.._ DATE----------------------------------------- -------------------------•--------------••---•-•------------- DATE------------------------- A ------ Alterations end/or recommendations: ----------------------- ---•---------------•---------•--•------- -•----•-- .--'-- ---- i.- - -- •---- ..•--- - --------`,`;- -------- ------------•------- --•------------------------- -----•- •- --------- -------- e FINAL INSPECTIO - -�,�,�-" -- _- � •-` - - Date------ - - --- ;s SAN JOAQUIN LOCAL HEALTH bISTRICT >r r Y3Md fi American Street 300 West Oak Street "' a �r Stockioornia 124,Syeamore StreetnCf Lodi,California *. 205 West 9th Street ' * ` Manteca,Californla E5 9 REVISE Tracy,California r. -59 2M 5-62 ATLAS; it da i?I Nu - - - - 4 ' CID 17/ S f