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FOR OFFICE USE: "" APPLICATION FOR 'SANIION PERMIT +w------------- —'. ------------- ----------- ------------ ------ --- (Complete in Duplicate) Date Issued / -' - --` � This Permit Expires 1 Year From Date Issued 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. S49. JOB ADDRESS AND LOCATION---------S-4-1-0------------ -------- W -p�7 Owner's Name----------------- ------------ ------------------ ------ -------- --------------- ------------ --------=------ Phone----------------------- - Address- t (� 2 ` ---I-- - ----------------------- -------------------------------------------- x �" Phone -----•----------------•- Contractor's Name------ -- Installation will serve: 'Residence 5f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1 Number of bedrooms _ Number of baths -_-�_-- Lot size --- 3---r -----------!r___ - ------- Water Supply: Public1system ❑ Community system ❑ Private Depth to Water Table Si ft. Character of soil to a depth of 3 feet: Sand [j Gravel F-1Sandy Loam ElClay Loam [IClay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date................... ) No ' New Construction: Yes CK'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _MateriaL_r✓—4 ----------- ---- Sep�tic{Tank: stance from nearest well__- �_- -Distance from mfou found -__p_-_. . [J X�I� No. of compartments _. 7- Size------V---'Y �----------Liquid de fih----- : --Capacity------ ' Dispo I Field: Distance from nearest well Distance from foundation__ ! �'f'_.Distance to nearest lot line__ _-f__ Number of lines__".._____"_____ �.___-__-.-_ Length of each line---------- ---17.7 �t--".Width of trench__..___ -:---•------------------ Type of filter material. .,,.- F epth of filter material____._ - ----------Total length___._______ p---------------,----- Seee Pit: Distance to nearest well-fmi�" _Distance from foundation___-_ J- ---------Dis�anc to nearest lot line-----It-_____._ �1b4 Size: Diameter_.._ ---------Lining material Depth - o _ Number of pits.--------1-- �3 .. Cesspool: Distance from nearest well-----------------Distance from foundation__ _____--_..---__.Lining material------.-------:---__.----.____ ads. Size: Diameter---- -------------------------------.Depth--------------------------------- - -------- ----Liquid Capacity----------------------- 9 1' Priv Distance from nearest well---------- Distance from nearest building---------------------------------- ------ ------------- ❑ Distance to nearest lot line- ---- ---- -------- ---------- ------- --- -----------•------------- -------------- ------- : ,- ' ----------------------------------------------•--------------------------------- Remode4ing and/or repairing (describe--------------------------------- --- --- ----- -----------------•-------------------------------------------------------------------"----------------------------- - - --------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 of the San Joaquin Local Health District. (Owner andfor-Gen#raeFea)-- •---- - ------------------------------------(Title)----------------- ---------- --- ------- -- ----------- By:--------------------------------------- (Plot plan, showing size of lot, location of system in relation to welds, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY G� ff� APPLICATION ACCEPTED BY----- ------------------------------- ----- DATE---------�1-_..----------------------------------- tREVIEWED BY---------------------------------------- --------- ------------------------ - -------------------------- DATE BUILDING PERMIT ISSUED--------------------------- 3 f�v DATE i Alterations and/or recommendations:_____. - r ------- -" ------- ----------------------- ------------------------------------------------ ----------------- F ----•-----------•----------------------------------------------------------- --------------- ` ------------ -- -------------------- Date--- ------------Date--- ------ FINAL INSPECTION BY:_..._ ---`------- �f{/ " l SAN JOAQUIN LOCAL HEALTH DISTRICT + 1601 E.Hatelton,Ave. 300 West Oak Street 124 sycamore Street 205 Wost 91h Street ,1, - Stockton,California Lodi,California Manteca,California Tracy,California