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` FOR OFFICE USE: lJ =`_ APPLICATION FOR SAfNfTATION PERMIT Permit No. ` � '--b 6------------------1Q--- . pQ (Complete in Duplicate) Date issued (--~-_4_ _ - -------------------------------------- ------------------------------------ ---------- This Permit Expires 1 Year From Date tissued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workhereindescribed, This application is made in compliance with County Or nce No. 549. -------------------------------------- JOB ADDRESS AN CATION_ Owner's Name--!`---- --Q�� -- ---- -- - 1" + --------------------- Phone Address----------,-4a-/_X ---:--._.----------•--------- ---------•-------------------------------- --- - -- --��k--��- - - - -------•------•----•---•---- Phone----------------------------------- Contractor's Name------------ elp_.- --- -------------------------------- -- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment Nouse ❑ ❑ Number of bedrooms _�- Number of baths __/__ Lot size ___Q � --------- Number of living units: __ ! th to Water Table� __ ft. Water Supply: Public system ❑ Community system 1:1 Private ®�eP Clay Loam Clay ❑ Adobe �ardpan ❑ Gravel Sand Loam ❑ y ❑ Character of soil to aFdepth of 3 feet: Sand ❑ VA: Yes ❑ No Previous Application Made: (If yes,date-.------------------I No ��'New Construction-. Yes ❑ No [ FHA/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) __Material------------------------------------------------ Septic Tan - �! Distance from nearest well__ Distance from foundation_____________"__ Capacity_.___.._____-_..__._-_ 151(,I No. of compartments------ ------- j Size Liquid dePt� / --..._Distance to nearest lot line_ ---- I Disposal Fi Idae�' Distance from nearest well_- --Distance from founds � Width of trench. --"f---------------------- 10 Number of lines___---/ Length of each line__ /3 f Total length__ Type of filter material - �y Depth of filter material_- --------` k :--_-____Distance t nearest lot line ---- Distance fr fou dafion ,FfA y Seepage Pit; Distance to nearest well__ f ......- -- Size: Diameter -- Depth ------------------------- Number of pits--- -------------Lining material"_ _ _� Cesspoo Distance from nearest well-------_-------_Distance from foundation__--_____._ -------Lining material----------------_--------__"________- p aci# -----------------gals. El Distance Diameter------ -------- ----- -- ------- -Depth------------- ------- -------- ---- --- --------Liquid Ca p Y -------------------- C ---------------------------------Distance from nearest building------------------------------------------ Privy'. Distance from nearest well_________________ - -------------- ❑ Distance to nearest lot line------".____- ----- -- ----- ------------------------------------- ---------------- - Remodeling and,/, repairing [describej_______________(s - ------------------__.-_.__ f -------- --------------------------- ------ - - - ------- ------ -- = I hereby certify that 1 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. Contract --- (Signed)---------------------------------- (Title)...��_) -------------------------------------------- ---------------- -- (Plot plan, showing size of lot, location of system in ation to wells, buil ings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------- ---------------------------------------- DATE DATE_.-- �'� -r --------------------------- - -- - ------- ----------------- - - - ------------------- - --- ---------• --------------------- --------- ---- REVIEWEDBY---------------------------------------- ------ ------- ------- - -- -------------------------- -------- ----- --------- DATE---------- ------------ ------ - ---------------"--------- -- BUILDING PERMIT ISSUED ------------------ �- Altera#ions and/or recommendations----------- ------------------------------------ ----------------------- ---------------- ------- - ---- q."a : ---: ------------------------ -------- � _:::. a - a.� Date -- -------- ----•---•----- --- -------- - G ----------- FINAL INSPECTION BY:____-Ir-.-.---��-------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 124 Sycamore Street 205 West 9th Street 601 E.Hazetion Am 300 west Oak Street Manteca,California Tracy,California Lodi,California 2 Stockton,California ' k - F.P-CG• - -'