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FOR OFFICE USE: - /—�a' - -------- ------ -- ---- --- APPLICATION FOR $A ATION PERMIT Permit No. -------------------- -------------- / (Complete-in Duplicate) ! .... . .IL This Permit.-Expires 1 Year From Date Issued Date Issued ./ . 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. J08 ApDRESS. ` `N.D OCATION_. ��' P7 ------ --------------------- 30 Owner's Na .!` _ / D`i7- 3 v �r�r+ 1. ...... /++� '1 one. Address _ '. W. aeS /s .., .��n woe ter —Contractor's Name-----..--- V,7_11 _ --�! -- - j4- - ---- ---- --- - X------- -------- Phone------.....----------- --------- Installation will serve: Residence -- ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other vice Number of5living units: Number of bedrooms ..-=_ Number of baths .__----- Lot size _.-��.._xj�;�l.......................... Water Supply. Public system X Community system 0 Private ❑ Depth to Water Table --- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel [� ,Sandy Loam E:] Clay Loam Clay [-] Adobe[] Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No New Construction: Yes No ❑ FHA/VA: Yes ❑ Nox j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public Sewer is available within 200 feet. - Septio Tank:" Distance from nearest wet#---A/A,.-.Distance from foundation-_ -___—".....Material No. of compartments---------------� Size__-r :�.a'. Z -_:._Liquid e th_ � _Capacify_ a rA/1 p� p t Dis osal Field: Distance from nearest well....-.-� Distan ce from foundation...0.- ......Distance to nearest lot Number of Imes..............z- -..-.__Length of each line.Cal.. r C_*......Width of trench .----cA-1---------....__.----- Type of filter material _1A44- aO _Depth of filter material----- ----- otal length---_------j/0Z----------------------- Seepage Pit Distance to nearest well-------------------._Distance from foundation....................Distance to nearest lot line___-._.-..._..-- Number of pits..--_............ Lining material--------------..- - -- Size: Diameter----------------- - ---Depth-------------------------------- Cessp ol: Distance from nearest well ----------------Distance from foundation................. ..Lining material----------------------_--------------- pt -h StoSize:ize: Diameter_ -- -----•. ------ = _-----..De "4--- ---------------------- ----------------- ---Liquid Capacity--- ------------------------gals. 4 • --- - - Privy: , !Distance from nearest well........................... -----_---___---_......Distance from .nearest building.____-......_-._____._-------.___.__--. ❑ Distance to nearest lot line ------ -------------- ---- sj 'Remod S g and/or repairing (describe --- -- --- - --------------- --- - -- - �---- ---- -- --- - ---- ---------------------tyt.Ct.Cd ------ - - - ---- ------------------------- - I hereby certify that I have prTared this application and that the work will be done.in accordance with San Joaquin County ordinances, State ws nd r es nd reg lations of the San Joaquin.Local Health District. i ' t (Si ned -- --- ----------- -- `� g =\ k ------------ ----- ------ --------------------------- ---- -- ----------------(Owner and/or Co_ntra�tor) BY ----------- - -- --------=---------------'------ -----(Title) -------...----- - ...... . .... (Plot pla showing size of lot, location of system in relation to wells, buildings, etc., can be placed on rreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY a �.R` �` ---=- -------------- DATE-"--. - ------- REVIEWED BY------------------------- - ------------------------------------- - --------------------- -•--. DATE BUILDING PERMIT ISSUED --------------- ----- - DATE ------- - --------------- Alterations and/or recommendations:_-_--- -://- :_--_pr-_--- --------------------------------- --- --------------- --------------------- --"-------------- -------------- ................................---------------------------------------------._....._.._........-..-.......----..-......-.._..----.--..-...---..-_._...-------.._..-----_---------------.-------- --------------------------- ..........................................:4_. FINAL INSPECTION BY:. ----------------------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street } 205 West 9th Street Slocklon,California Lodi. California Manteca,California a Tracy,California E.H.9 2M 1-67 Vanguard Press , ' 3 7 1 i