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~� FOR OFFICE USE: J SL APPLICATION F(�R—SA':- ITATION PERMIT Permit No. -.Q- �' .. ------------------------------------------------ (Complete to Duplicate) 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. pp This application is made in compliance with Count Ordinance o. 549. 4 Y 9- JOB ADDRESS AND LOCATION---------------- Owner's Name---•--••-------------C--E-------- -+-------- ----'-t-5 +��Ll ---------------------------- Phone 2 S - - r ._. Address----------------------- --- Contractor's Name------------•-----------•- -- - - --- -•----------._ - -------------•---- -- -------- ----- Phone-1��3.` - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g - &v-------�� 3 .l___ Lot sae .------¢.-�-=X Number of living units: _..l_ umber of bedrooms .__._-.. Number of baths -- Water Supply: Public system [Community system ❑ Private ❑ Depth Water Table ft. o Hardpan ❑ Gravel Sand Loam [Clay Loam Clay ❑ Adobe❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y IJ Previous Application Made: (If yes,date--------_----------) No New Construction: Yes [No ❑ FHA/VA: Yes El No 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-W-10--- from foundation---_1-Q--------Material=,.-----�L.N=-"v r p� X 6J/QQ�Liquid de,th------ - ........ Capacity No. of.compartments_________--vz--------Size--- --_- --- r �Qf ,�n1 1' D's po Field: Distance from nearest well----der --_-__Distance from foundation__._._!_ ___-_-_-.Distance to nearest lot ling,-_- Number of lines______._-__.. _"-- ------------Length of each line___. ��-� -fy� °.Width of trench-__....�yY ---------- s e th of filter material_. --_f s - -----.Total length--------1_ -------- -- Type of filter material_ _ <-�- p Seepage Pit: Distance to nearest -ell---_._--`---.-___----Distance from foundation__ Distance to nearest lot line_______._.____.__ m Number of pits---------------------Lining material---------- --- --------Size: Diameter------------------- ---Depth-----------------------------" -- ' Cesspool: Distance from nearest well-----------------Distance from foundai-ion--------------------Lining material__-.-- ---------------- ❑ Size: Diameter-------------------- ---- ---------Depth----------------------------- --------------------Liquid Capacity----------------------------g , Privy: Distance from nearest well_-----_----------------------------------------- Distance from nearest building------------------------------------------ Distance to nearest lot line.__----------------------------------------- - •- Remodeling and/or repairing (describe)----------_----------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- ----- --- ----- - ----------- --------------------------- ---- -- - 1 here- -by- --certi--fy 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 re ulations of the San Joaquin Local Health District. y (Signed)--- --- -- - --- -------- ---------- --------------- (Owner and/or Contractor) ' Tttle (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-- -�-f�1� -�d----------- ------------ -- -- -- ------------------- ---------------------- DATE_..•-------------------•------------------------------.----- REVIEWEDBY--------------------------------- ------ ----- --------- --------- -------- ---------- --------------------- --------- DATE------------ ------------- ------ - ------ -•------------- BUILDING PERMIT ISSUED----------- ------ >------- 6 -...-_ i1Q3 - :' ---? v---- '� Alterations and/or recomm�elr dations: e__. - � ___ � . o� --------- - --•---� -- - ------ � -- 3 _____________"- ...___._-..._____..._ ___.._""- _._____ __.-------------------------------_._...._._--_________ --.._..___."__. r - -Y' Sal �s/Ir l� r* Q �Pj`l� 1'� Date -----f� .- �e-� z / _ FINAL INSPECTION BY:- --- `--- ----- --------- --- ----•---------------- -------- ------ AOL- 0CM '._ � SAW70WWN LOCAL HEALTH DISTRICT S SG rG�� t 9th ree 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street / 5 Lodi,California Manteca,California Tracy,California Stockton,California J- _ I S