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FOR OP1 ISE USE: ----------------------------------- --- --- '. lff6.0 3 APPLICATION xFOR SAW ION PERMIT Permit No. ....... .............. - --- - ------ (Comple#q:`ht Duplicate) _. This Permit Expires 1 Year From , t .;. ssued Date Issued __ �_�_.. Application is hereby made to the San Joaquin Local Health District fa ii t&construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Lil; Vim- L50 JOB ADDRESS AND LOCATION______PL),_ 5T1-14________RD-------------ll•�Ga----.�- -- ----- - -. ------//K// Owner's Name--&(EUaRp..........O ------- :--• - --- - -- ------ Phone------------- --------------------- Address �-�� '�____-------�..------..41&-.----_. ---------- T ------- ----------------------•---------------------------------------•-.-•-.. Contractor's Name----t0V.V/_V.F_P--•--------------------------'-------------------------------------------------- - --- Phone----------------------------------- Installation will serve: Residence f�j"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms 3__ Number of baths -Z_._ Lot size -------&}Fu�-------------------------------- Water Supply: Public system Q Community system ❑ Private epth to Water Table .6-_ ft. Character of soil to a depth of 3 feet: Sand [!K'Gravel ❑ SandyLoam ❑ Clay Loam E] Clay ❑ dobe E] Hardpan E]Previous Application Made: (If yes,date__-- -__----_.--) No �w Construction: Yes E] No FHA/VA: Yes ❑ No L� TYPE OF INSTALLATION AND SPECIFICATIONS: - - - -- - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep is Tao,-- Distance from nearest well.____ .Q____Distance from foundation----/ ---------.M -------------- No. of compartments----._-. Size__ X,.l____ �.___Liquid depth___11X-Z..-----Capacity_141Q4?... Disposal Field: Distance from nearest well---50---_Distance from foundation---1Q_.---------Distance to nearest lot line__ �_•._ ENMTl1`46 Number of lines----------1--------- Length of each line_.___. ---- 4 f Width f trench _o _ t Type of filter material___RO__C �._--Depth of filter material_-__ � ___-.__..Total length__--_-__--�Q____-__--_______ADO � Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------:Distance to nearest lot line----------------- 1-71 --__-_.__- -_❑ Number of pits---.------------------Lining material------------------------Size: Diameter-----------------------Depth----------------------._......... �f Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------Lining material----._.-_____-.___.._-_•-_.--_______- ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------Liquid Capacity--------------------- ------gals. Privy: Distance from nearest well------------------------------------------.------Distance from nearest building ❑ Distance to nearest lot line------------------------------------ -------------------------------•------------------------------------------------------------------------ Remodeling and/or repairing (describe):---------------------------------- _---------- ------------- -------------------------------------- ----------------------------------------------------------------mo SJ_5PT(-C-------rBf' K--------M)-[----------1Q----------FRAM ------ 1_A,you r------D�srz� = 'T,R- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- Z I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Co iWinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------AA-A='-`--e'------ --------------------- -------------- -------- ---- ------(Owner and/or Contractor) By:------------------------------------ -------------- - --------- ---- -------------- ---------- ---- - -- -----(Title)--------- --------------- --- ---------------------- -- ---- -- - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). CI FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----'T—,-R-,-O------------------------------------------------------------------------ DATE-------- ---------------- REVIEWED BY------------------------------------ -- --- _ ------------------ --------- --------------------- DATE--------------------- •------------------------------------- I_ f - BUILDING PERMIT ISSUED-------------------- I_F ..•. -�4N-K------J ET- DATE Alterations and/or recommendations:._ _�N - --- �.--_ _�W�� 5.A. _5 K----------------------- 77 ------------------- ® ----------- - -- 5 - - -7—0 T ------ -- -- ------------ ----- a---------------------- ------------------- ------ -- -- -- ------ - --- -- - ---- ----- ----------------- ------ --------- ------------- ------------- ------------------------------------ - - -- ---- ---- - -------- - --- ----- - - --- -----f �J. -- FINAL INSPECTION BY:..-.I.. --------------- Date------ ---------------------- ------------------ --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California " Manteca,California Tracy,California F.P.CC..