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FOR OFFICE USE: b 5 0 5 87010 4 " APPLICATION FOR SAFIITATION PERMIT Permit IVo_ _______________________� (Complete in Duplicate) Date Issued ---- ------------------ T 'This Permit #`x Tres 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. r pP with County Ordinance No. 549. This application Is made m compliance P JOB ADDRESS AND LOCATION------ -- -------- - -- � N Phone Owner's Name-------------J ------- -- - --- -------- ---------------------------;--------------------------- ------ -------------- ----------------------- Address------------------------------ -----Address------------------------------ k " - ------- --._. Phone----------- ---•-•----•----------- Contractor's,Name___________________________"___ - Installation will serve: Residence Apartment House ❑ Commercial [ITrailer Court ❑ Motel [I Other. 1]. Number of living units: _-- Number of bedrooms _3___ Number aths ---�___ Lot size ____ _Q�-----.- ------------------------ { - : :rte . `1 ft. Ir Water.Supply: Public system ❑ Communify*system ❑ Private Depth to Water Table _�7_ Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ ndy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ I t Previous Application Made: (If yes,date----------- --------} No [ New Construction: 'Yes E] No FHA/VA: Yes F1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .. 4 � f i Septicank: Distance from;nearest well__.-�Distance�rom foundation._._ __ r/ No. of compartments----------�`---�---Size---� -- /Q.f_ '.--Liqof uid de p(h____._____.t' ------ Capacity--- - C7 /'� of line�_. __�...._. Dispo al Field: Distance from nearest well--- _.....Distance from foundation f________=_.Distance to nearest I Number of ------------- ---------- ength of each line--------�Q Width of trench._____ �---- rl Total length--- --4- Type of filter material___- _. epth of filter matenaL___---f"00--------- f r ' �C� lot liner _ _ .---_.______ I - Seeps e Pit: Distance to nearest welL...____�____J..____Distance fro foundation Distance to nearest_". ' ( Number of its--------- -----Linin material------ _ - - . z Diameter-------�- Depth------r�0--_"".-----.---- Cesspool: Distance from nearest well________ ".__Distance rom foundation--------:-----------Lining material............... _t______._ ❑ Size: Diameter--------= y t ,, .�- ."-------------------- ---------- >Dept.h_w:--------��-- ------- �--=---- -Liqu d Capacity--- --gals. Privy:: Distance from nearest well __----T__._..___--. "'--_.Distance from nearest building------------------------------------------ ❑ ---- -------------------------------------------- ----- ------------------- Distance to nearest,.ot line Ys Remodeling and/or repairing (describe):- - -------------- ---------- ---------------------------------------------- ------------------------ ----- -------------- •----------'------------ ------ I i --------------------------------------------- `--- =-------------------------------------------:--7.-------------------- I hereby certify that I have prepared this application and that the ark will be done in accordance with San Joaquin County ordinances, Stat aws, and r les and 1 lations a San Joaquin Local Health District. (Signed)--------- --- --- --- -- --- -------------------- ------------------------------------(Owner and//r-6orrtrac+ari Title ----- (Title) (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------ ---------- ------ ------------------------------------ DATE v -== I REVIEWED BY- ----------------------- =--- -------- ---------- ------------- -----------------------------"--------------- ---- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------------------------------- DATE--------------------------------------------- --------------- Alterations and/or recommendations ------ ------------------•--------------•--------------------------------------- ---------------- --------- ._ 1, FINAL INSPECTION BY------- ---- ---------- j Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.