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til cfe-7p's � �a FOR OFFICE USE: — 86 fs— t �� - ------ '�- 0 Permit No. - �� / -. APPLICATION FOR SIANIT/XTION PERMIT , `! ^ ------ (Complete in Duplicate) Date Issued ' This Permit Expires 1 Year From bate 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. • � , A�f ------------------------ i ��--------------•------------ s� ��- JOB ADDRESS AND LOCATION.______ ! ?------- �� �r � ------------ ----------- Phone-�---�-=-----••--••-�---- Owner s Name---------- ,_2Q :- ------ -- .: ,-� �fT`�- -1` i' � - ------------------------- Address = ----•------------------r�- s i Contractor's Name . ' A- Apartment `�/ �� > �� Phone. •- � House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑Installation will serve: Residence ❑ % 7 X- �� Number of living units: __�_.- Dumber of bedrooms J_ Number of baths _�-.-- Lot size _______ Water Supply: Publicsystem ❑ Community system ❑ Private ❑ Depth to Water Table __- ft. I 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [E-,-Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date._____-.---_-___--) No New Construction: Yes ❑ No E-"FHA A: Yes ❑ No f 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________________Dis#ante from foundation____-_______--.._._.Material-__-.___-__-____-___-___-_____-------------- No. of compartments--------------------------Size--------------------------------Liquid depth--- ----- - ----.__Capacity Disp❑osaf Field: Distance from nearest well ----------Distance from foundation------.-_________--Distance to nearest lot line_____----____.-_- ❑ Number of lines __ __ Length of each line _-- -----.Width of trench---------------------------------- Type of filte ,mat�rial_= ___-._ T__Depth3of filteramasrial __�aotah length_---------------------------------------- Type - ---------------- ---�----------- _____Distance fr foundation__A�_________Distance to ne artist lot line ----------- Seepage ----- -- SeepagePit- Distance to nearest well-.__ __ 7 ii F - Q • Lining ❑ Number of pits-------Z----------- g material-- _ fP Size: Diameter._. 3_. --- Depth----- --- ---- -----' !. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mate rib e_-.----'--- ------------ als. Size: Diameter------------------ - ---Depth-------- -----�-------------- --------- -------.Liquid Capacity 9 Priv Distance from nearest well ------------- ---------- ---------" -Distance from nearest wilding _- _____-_______--_---_------------: y: s +, .41L, A------------------------------------�----- 11 ----------------------- Distance to nearest lot line._...____ -,_-_ _ 1 ---------------------------- Remodeling and/or repairing (describe) �� `s l --------- ---- '-------. IVS ---------------------------------- I I--------------------------------- ------ ------------- ---- -! /' - c� �� - -- --- -- -------- -- - -------------------------------------- - ----- --- ------ ------ -tea. --r�w�+,�c+-BssG F I hereby certify that I have prepared t is application and that the or �will Abe done in accordance with San Joaquin County ordinances, Stat P. and rules ands' ations of the San Joaquin'L cal"Healihh District, fwn and/or Contractor) } (Signed) ------------ Tl -g le (q ) i (Plot plan, sl'inwi�siz of lot, Iota on of system in relation #o wells, buildin s, a# ., can be laced on reverse side). FOR DEPARIVENT,USE NLY APPLICATION ACCEPTED BY--------- - - •• � I DATE_ _ �f 65------------ ----- - ------_-- , ------- - REVIEWED BY -•------------------ ----- -- BUILDING PERMIT ISSUED___-_______ �-- DATE Alterations and/or recommend tions._-.-.......... ---- -- - - ------ Ail r -------------- ------------ --------------------- Date /2-«_-C f FINAL INSPECTION BY----------_ -- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Ha:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California