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675 {.. �..�° 3 0 1 APPLICATION FQIt SANS "�""' TATION'� 9RU IT Permit No. (Complete in l)uplicate) 1 / Date Issued _�i Applicat�n is hereby made to the San Joa uin gCounty Od�nancealth DlNoc549r a permit to construct and install the work herein described, This application is made in compliance with JOB ADDRESS AND LOCATION. Owner's Name_ o -- F -------------------------- -.� ----------------------- 7--- ------------------ ------ 'hone-- Address ------- -- �.� -- -- / /n z---------- Contractor's Name------- -----------------------------------...--•-----•-==--------- b.�- ----_----- a---- Installation will serve: Residence p -----. Phone----------------------------------- } �A artment House❑ Commercial ❑ Trailer Court i Number of living units:N_l,--- Number of bedrooms ❑ Motel ❑ Other ❑ Wafer Supply: Public s sfem ' Number of baths _ _____ Lot size _-__.____ m ! X---/0>Q--------------------- Character system rCommunit system ----� ------ ----- Y Y ❑ Private ❑ Depth to Water Table '_ --- ft- Character of soil to a depth of 3 feetSand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla Previous Application Made:`:, Yes ❑ No Y Q Adobe' Hardpan ❑ TYPE OF INSTALLATION (AND S' S: instruction: Yes ❑ No G��' (No septic tank or cesspoollpermitted if - P public sewer is available within 200 feet.) 1 -,-' A _ _ Septic Tank:- Distance from,nearest-well"._..--------�-Distant 'frorriti�foundation,_._�o- -------.Ma erial- #. � N . ofom artments_ k ------------- { p Size ------ Li uid de tf� _.a_ �. i t q p - Capoca e Cam - posal ,Field:; Distance from nearest wel��---_-_ Y� -------------- n ------------ _... ___--__--.Drstance from foundation ------.-Distance to nearest lot line_.--------------- Li •5----- Nu`mber of lines" =-'-•7-= - - 3_ Length of each line -- �.....` "`ra _. - �'; Type of filter material' Width of trench-.-._-._Z-�-�1 - [ epth of filter Mali eia_-------- - / V�1 Seepage Pit: Distancetto nearest well.;:+_ ��-1----Totai length______--------------/ Distance from foundation____________________Distance to nearest lot line__---_----_-- ' ❑ Number of"pifs.�-------------= xLsrning material------------ 1 ------Size: Diameter Depth--------------------------- n - oolr --------•=.Distanc-e-from—foundation:_.___---; -�Lining material----------------- Qr ❑ _ Distance a Diameter nearest--------------~..----'.Depth----•--•--•--------- .. Privy: Distance from nearest�weil-------------=-`- Liquid Capacity-- -------------- ---------gals. El -----------------------Distance from nearest k -stance to nearest lot,line._.___--.-_-_x•------- building, ------------- Remodeling and/or repairing (describe): f ----- ------- I � r' i ---------------------------- ----------------------- ------------------------------------ ' ------------------•--•----------- ---- �-` - --------------------------------- - i ------- -- _� ---------------------- ! hereby certify that I have prepared fh"is application and that the work will be done in accordance ith San Jo ordinances, State laws; and rules and regulaL' s of the San Joaquin Local Health District. , aquin.County (Signed)_~��--•-------•--�- 1 : , , F t :�`-r__ ------------(Owner and -- ------------ -- By-------------•- � � I --•- /or Contractor) - --- ----------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc.,.cannbbe�piaced on l;:erse side. FOR DEPARTMENT 115E ONLY APPLICATION ACCEPTED BY--------:---------- -- { REVIEWED BY.-----------I - -- ----- -------` - ------- - su ' ; ----------------- -- -- ------------ - -- - -------------- DATE---------�----'-- -`-•----------------•--------------------- ILDING PERMIT 1S- UED-------------=------------------------------ -------------- ----- Alterations and/or recommendations_____________-- k DATE_____-.____ ----------------------------------- ---------- --------------------------------- ;""" / ------------ ------ - �» ------------------------- ------------------- -------------- / - ---- _ - - 4; c— - _ _________________________________________________ II -------------__-----------------------__---------___ ------________________ lij� FINAL 'INSPECTION BY------------------ --- ------- �i1, �' r7 ----- Date--- !�----------------- --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak $tree+ Stockton, California !32 Sycamore Street Lod814 North "C" s}reef Lodi, California E5-9-2M 10-52 Revised Man}sea, California Tracy, California W-210p •