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APPLICATION FOR SA ` NITATION PERMIT � Permit N f � Z (Complete in Duplicate) o' Date Issued / Application is hereby made to the San Joaquin Local Health District for a permit to construct and This application is made in compliance with County Ordinance No. 549. install the work herein described. ' JOB ADDRESS AND LO ON 1.1174-7 A/ Owner's Name �U.--� ----h-STG!s -- T Address -- 11-A--a-"41 _" Ph ------- onf __ Contractor's Name . ........ Installation will serve: Residence ' Phone." . Apartment !-louse ❑ Commercial Number of living units: - _-" Number of bedrooms 0 Trailer Court ❑ Motel Number of baths ❑. Other ❑ Water Supply; PLbIjC system ❑ Community system Private '�`-- Lot size "_"- ro�v" ❑ Depth to Water Table ys Character of sail to a depth of 3 feet: Sand ------- ft. Previous A ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Application Made: Yes p. No New Construction: Yes ❑ No ❑ Clay ❑ Adobe ardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ASV'°" Yes ❑ No. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -__ Distance from foundation--_--___-__ o. of compartments----------- - Size----•-____--_ --------Material"----- ---- ---- ---- �-------••---- --- ------ Disposal Fi ---------------Liquid depth------------------------ Capacity.---------------------- - Distance from nearest well-___-d [� Distance from foundation _�U---------Distance to nearest lot line-- ------- ---------- f _____ .t9sv Number of lines_ /_ Type Y ------- ------------Length of each line-----_ - yp of filter material__f`bC,Y- Depth of filter material- -W�dth of trench_ / ' i See a e P' ' --------- p g Distance top earestw ell_"____ Total length, -----Distance from four ation__-•f_e "" Number of its._----_._-_._--_-___ Lining material--_Yoe `---"Distance to nearest )ot line- Cess ool: ' - _.size: Diameter '' % ---------- p Distance from nearest weft-----___-_- c- `1-- Depth----o1s� n v Distance rom foundation-__-_-__-__ ❑ Size: Diameter----------------------------- Lining material---------------------------- Privy ----------------------- ------------------------------------- f "' Depth -------------------------Liquid Capacity---- al { Distance from nearest well ------------gals. tA' -- -- ----------------------Distance from nearest building .� Distance to nearest lot fine__.__ __ Remodelin and ---- --- ,� ----•------ ring (descriLie)---- ---------�� ------------------------- ------------ ------ - ---- - fl --- g / ------ P ----------------- -----------.--------- -----• --•------------------------------•-------------- ------------------------•-- --- --------------------- ----- ----- - __ •--- -------- ---------------------------------------------------- _ -------- I hereby certify that I have prepared #his ap lication and that the work will be done in accordance with Sa ----------------------------------------- ordinances, State laws, and r n regulatio o the San J ----•--- ----------- ---- Local Healt [strict, n Joaquin County (Signed]__-- •--------•-------•-------- - ----- ------------- --------------------------------- _(Ow rand/or Contractor (Plot plan, showin size "- --�""- - - 9 , locat n of system in.relation to wells, hail - ---------(Title)--_-- _-" , etc., can be placed on reverse side). -.�— FOR DEPARTMENT f15E ONLY APPLICATION ACCEPTED BY_ 1�-"t.-,v_C �- ------------------------- --------------•------------------------ DATE -REVIEWED BY---t------- BUILDING PERMIT ISSUED-_".__,.____ " DATE---- ------ -------------- - ------------•------------------------------------ ferafions and/or recommendations------------- DATE.------------------ - ----- --------- -- j _"_.." �. ---------6_rI�:------- - 0 .� ----- -------- ------------j-- ---- ----------------------------------------- ,2,,FINAL INSPECTICN - -- ---�--- Date-- ------- 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 360 West Oak Street Stockton, California 132 Sycamore Shoat Lodi, California Manteca, California 814 North "C" Street ES-9-2M Revisea1-57 F,P.CO. Tracy, California