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mm FOR OFFICE USE: ----:-=,`� --------- - 3 S 3 - Permit No. ..... .... ...... r- --- APPLICATION FCR�SiUNITATION PERMIT I y fi' -' � (Complete in Duplicate) } I ------------ 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 a plication is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND CATION. -„�✓1�?_ -S ----------------------------- ! "s Owner's Name--------_ & �WI�i--- ---=-- Phone.-- •--------------------------•-;- Address----------------•--- ------- -• ---- --'A ------•------------------------------------- Contractor's Name-------- ----- -- e� •u� -Cel -------------------------------------------------------- Phone I ------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __i___ Number of�bedrooms.a--- Number of baths _� Lot size ------'7_?` / -------- ----------- ----- Water Supply: Public system ❑ Community system �rrivate ❑ Depth to Water Table f h. Character of soil to a depth of 3 fee+: Sand E] Gravel [I Sandy Loam El Clay Loam Clay Adobe C] Hardpan ❑ Previous Application Made: (If yes,date__,.__---_.__-__-) No 2 New Construction: Yes �]/I'do E] � FHA/VA: Yes DRo"'No El TYPE 0,F-1NSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l-? Septic k: Distance from nearest well-------`_`'-__Distance from foundation_ /A /_._.Material_._. .8P1 1-it------ k `LI uid de th__-_.___ Ca pa city_____.� =e?--'� No. of-compartments" -- ---------•----Size--��f-�-�}��,� 9 P. ------:-------� Disposaeield: Distance from nearest well....=- "Di'stance from foundation___,C-_ .._- Distance-'to nearest lot Number of lines----la----j Viv----------Length of each line------- .b ? .Width of trench--��7- Type offilter rnaferlal--_1/,k r1��a ”-D'epth of•filter material-___ _..1-------- otal length______------I- - -- "Seepage It: Distance to nearest well___._..`" Distance fr foundation_/_�O_f____-Distance to nearestloi Une____,�___ Number of pits__..--- :______lining materia__-_ .-Size: Diameter--- .--`.f-_--Depth.. .. --��?- Cesspool: Distance from nearest well__.-__--.___ Distance from foundation_...._- ------.Lining material_.......°___________________________ Size: Diameter---- - ------well ------ -'.-.Depth---------- ---------Distant -- ---------- -Liquid Capacity-- ----`--------------------gals. t t :Privy. Distance from nearest ------------------------------------ - e from nearest building-------- ---------------------------------- W ❑ Distance to nearest lot line....---------- --------------------------- ----•------ y " -- --- Remodeling and/or repairing (describe):---------- - ~-' - -- ----------�m " -- --- S7 - -------------- ---------- ------------------ ------------------- ----------------- ----------------- --------------•-------------------------------------- ------- - _...... here certify that Ihave----•------------------- ---------------------------------------------------------------- ----------------- -------------------- ------------- -------------- I h' i Qrepared this application and that the work will be done in accordance with San Joaquin County t ordinances. State Iavv2s:,'3d rules and,xe ations of the San Joaquin Local Health District. { V► `X ; (Owner and/or Contractor) [Signed} ., k i t. - Title-----( --- By: ---------- L ) G .°.G... ,-... (Plot plan, showing size of lot, I ation of system in relation to wells, buildings, etc., can be place on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- DATE I REVIEWED BY' -"# DATE - DATE-------------------------------------PERMIT ISSUED----- --- ----------- r 1l. ... .. "`= -------- - Alterations and/or recommendations:___.__.._ . :. ?-----`--------'--,... _t r ---------- --------------------- - ----- I (� C---r—S r_... F ------. -------------- --- ------------------- "--- ., ------ ----------------------------- ----------------------- .h FINAL INSPECTION BY:-------` __--- - e f � ----- Date fNJOAQUiN,LOCAL HEALTH DISTRICTS 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California