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FOR OFFICE USES -------------------- ----------------------_____----------------------_------ APPLICATION FOR SAIW..TATION PERMIT Permit No. --------- - -------------------------- ------------------ {Complete in Duplicate) This Permit Expires ] Year From Date Issued Date Issued ./Z/__ 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. 549. �} t JOB ADDRESS AND �LOCATION.... f� g/r, - '----=----- -- L , / �. - L•r ---- Owner's Name----------- --- Phone. Address------------ Contractor's NameI IF - ------------------------------------ Phone Installation will serve: Residenc`e6,❑ Apa rfinent,''House ❑ Commercial~ Traile Court ❑ Mote] ❑ Other ❑ Number off-lliiving units __:___ Number of bedrooms=-_ Number of baths --y-f Lot size __� _.-_ __l__Dp____________________ Water Supply: Public system �Comrrunit s stems t Private Depth to Water able __ f N#0 ,pq l Y" Y ❑ ❑ P i 7 ft. v Character of soil to<depth oe f 3, t: S 01- aannd 0 Gravel Sandy Loam ❑ Clay�Loam [] Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_LAll, �._:� �s No ❑ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No P- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_---�____DistanQe frgm coup d9tio�n-_.r �_.______-Mate�al_,ZOe"_-4'r' - ( tNo. of compartments-.° --..-T.____._..__Size%W_3K�°�__ ,quid depth----Y----------------CapacitygvA�_..___ Disposal Field: ,Distance from nearest well------ -___Distance frornVound�nj___eV_ .__.Distance tornearest�t line_ __.___.. Number of lines_:______ ------ :Width oftrench�----------•------------------ Type of filter material- ', f!.r—Depth of filter material-__.AF� Total length-----. 2 W.-_ ____________________ Seepage Pit: t'Distance to nearessst��wO ______Distance fr m foundation-----`!___.-_.Distance to nearest lot line__-. (� . ,Number of pits-_a--�_______,_.__.Lining is /_..Size: Diameter-__ -----De th_ Cesspool: ` Distance from nearest well-----------------Distance from foundation._ -----------------Lining material-__.___....._____--_---_-_._____.___. ❑ Size Diameter-------------------i!1Depth---------- ------ I-------------------------------Liquid Capacity- --------------------------gals. *,. : Privy: Distance from nearest well.._----------------------------------- ---------Distance from nearest building---------------------------- .... ❑ Distance to nearest lot line------ ---- -- -- -------- ------------- ` Remodelingand/or repairing (describe _ ---___ _ - ffr --- ... --- - ----- ------- ------------------------------------------------------- _ _ _ TTTT ---- --- -- --- ---- - - ------------------------------ _________________ ____ _ _-- --- -- --- .............. _________________________ ___________________ _________________________________________________________________________________________________________________.___....___...__-_----_-----_-_..__.. 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 rul and regulationof the San Joaquin,Locel'Health District. (signed) - ---------- Owner and/or Contractor) _.. � �} -. �,• -��: ��_�YWI�.' By: --------- Title (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). 1 : rJ -�- FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--------------- DATE------- -__--�----/------------- -- ` REVIEWED BY-- -------------------------------- - F - - DATE__._._. I- I .... BUILDING PERMIT ISSUED------------------- ----- -f --------------• -------------- D TE---------- ' 1 Alterations and/or recommendations:.__-__ � ' ^-9;C-- -.-•t.%:r _�cc - __ r'r�_. 5t --------------- It; „t4,- La <-�''---- ------------------ c...-.-------'-f�'-t/ ------ '''`�- ------------------- ------------------- a''v- �r --------------------------- ----- -- ---- --- -- •------ ------ ------ - r'= - ---- - ---------------- - - --------------------------------------------0-k -- -------- -----. r,,�i,_ ,e , .I` ------------- - FINAL INSPECTION BY ._. . " ------------------- ---- f Date = -------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT,,,,0' 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California