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FOR OFFICE USE: <br /> --------------------------------------------------"-""-- APPLICATION F.OR Sp/ ION PERMIT Permit No. ..sa -3 <br />----------- ------- ----------------- ------- ----------- (Enmplet3in _. .ate <br /> • ..., � Date Issued <br />_-_..____._____----------------------- This Permit Expi►es:'1'�(f3ar From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LO)CA_TION---. C f'a----Pd------------------- -�Phonea___._) <br /> ----------- <br /> Owner's Name-------------------N�=:� Q�7_6�pp 5t---"-----------------------••-•----------------------- - ----------------------------- ; ---"-- <br /> Address-----•---------------------�'------- -------1309__ATE------------------------------------------ --------------------------•---------------------------------------••-----•---------- ---•--- <br /> Contractor's Namelll-C��EC~---------------------------------------•----•----------------------------_-_ Phone <br /> Installation will serve: Residence 2-'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1___"_ Number of bedrooms ___ Number of baths I""" Lot size __nn___ --- _ad'�____________________________(�` <br /> Water Supply:, Public system ❑ Community system Private ❑ ,Depth to Water Table '°'!-__._ ft. 1^v <br /> Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Hardpan \.w_Previous Application Made: (Ifyesdate .--__�_____-_.._"a No ❑�ewConstruction: Yes [�__N""��o""❑��'�FHA/cV�A: Yes`❑TYPE OF INSTALLATION AND SPECIFICATIONS: aml u� �Ge�� I <br /> (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welL_t?$__Distance from foundation---I<_O-___-______.Material_____-.'_--_- ______--______ _ _____________ i <br /> dNo. of compartmenu-----------a�-----------Size_ -JO-�-`1------.---Liquid depth-- `�--------------- a <br /> Disposal„Field: Distance from nearest we€.;%r- _._-_.Distance from foundation--_P0_--___-_--Distance to nearest lot line----IR__________ <br /> Number of {fines_____________ Length of each line___-__- n`J.____- Width of tranch.__ a ---------_ <br /> 5--------- g /&-c> <br /> Type of filter material_5,J,_1�3f...__._Depth of filter material___--_1,9----------Total length_-______ ____________-___-____ <br /> Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line----------------- i <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------- - ---Depth--------------------------------- I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-_- -------- Lining material--____ -_.___---_.___-_--.- <br /> ..Size: Diameter_________________ __De th____----_.------------------- ----------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------.-------- ________________ _ ___ _Distance from nearest building-__-_---__________-__________. j <br /> ❑ Distance to nearest lot line---------------------------------- ----------------------------------•-------------- ---------------- ------ # <br /> Remodeling and/or repairing'(describe--- ------ --------------------------------------------------------------------------------------•-------------------------------•--- ------ <br /> -----------------------------------------------------"----------------------"-------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------- ---------------------------------------------------------­---------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws d rules and regulations of the San Joaquin Local Health District. <br /> - - ----_� �:. --- - =----------------------------------- <br /> By: <br /> --------------�-�'�- Owner and"/o�-Contract f),. <br /> 4 <br /> By:---- --------- -------------------(Title)--------------------------------------- --..._----------------- <br /> ------------------------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED ------_ <br /> i3 --------------- - DATE------- G oS` i 7, <br /> REVIEWED BY---------------------- - ---------------------------------------------------------------------- DATE---------------------------------- <br /> ------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------- -------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:---- -------------------------------- ------ - --------------------------•---------------------------------- ---------•-------••------------------------------ <br /> r, <br /> FINAL INSPECTIONB .. -- (�-- - -__ - -- Date-------��-� -P�7. _ <br /> SAN OAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California xr�3 Manteca,California Tracy,California <br /> F-P.r u, <br />