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FOR OFFICE USE: s, _ (. ------------------- --- --------------------------------- t APPLICATION FOR-SAWATION PERMIT Permit No. .. _1.......... Duplicate) :. Date Issued ___ _ : _. This Permit Expires 1 Year From Date Isst�¢'+ p Application is,hereby made to th ` San Joaquin Local Health.District for a permit to construct and malfthe work herein descrtbed. This application made, in compji e"'with County Ordinance No. 549. t ) f off' - OC�T O - JJ� � �6 ...... ........... 7 �U JOB ADDRSS AN , J � �E` --- iP - -- r 'Gf,� U C1�Owner's Name ' Phone------------------------------------ --------------------------------------- � �Address ------...R � - ------------------------------------- ti ' ----- !1 :..... Contractor's Name . F .. ----'1 ---------------------------------------------------------------------------------------------------------. Phone................................... Installation will serve: Residence E�- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.(----- Number of bedrooms ---I--- Number of baths J_--_ Lot size -__ -_________-_____.____ Water Supply: Public system ❑ Community system ❑ Private i❑' Depth to Water Table lS_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ )3K Dflcr f�)i) _T o� Previous Application Made: (If yes,date.-------------------) No New Construction: Yes Q'No ❑ FHA/VA: Yes [3 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 wel -Distance from foundation_._ ---------Material_ (GNB r: No. of compartments___Z - Size_yeY l!! _X -_ . :_-_Liquid depth_------ --------Capacity_ I Z c-_.- Disposal Field: Distance from nearest well.--.'. ----- Distance from foundation..__ ----------Distance to nearest lot line... ...... [ Number of lines-_____-�-- _______ ` C -__Length of each line________ __.` _ r,__-___.Width of trench--------- _ _____________ Type of filter material__R_C'_LF'_l-_-_Depth of filter material___-_ .�__-___-__Total length-------------------- ----- Seepage Pit: Distance to nearest well______________________Distance from foundation________-___-______.Distance to nearest lot line__.__.__________. ❑ Number of pits______________________Lining material-----------------------Size: Diameter----------------------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______--_--_-_____-__-____--_-_-_. ❑ Size: Diameter---------------------------------_.-Depth---------------------------------------------------.Liquid Capacity----------------------_---gals. Privy: Distance from nearest well _:_-___ . _______ . ____-.__Diss ance from nearest building------------------------------------------ 11 _______ ________________..__-._____- Distanceto nearest lot line------------------------- ------------------------------------------------------------------------ -------------------------------------------- Remodelingand/or repairing (describe)=-------------------------- --------------•--------------------------------••-- -------------------------------•--• ------------------------------------- --•---•--•---•---•-------------------•-•-----------•------•---•----------------•--------------•-----•--------•-----------------------------------------------------------•-----------•------------------------------------- ----------------------------------------------• -----•--------------------------------------------------------------•-------•-------------•-------------•-•--- ----------_--------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------- ----- •-------------------------------------------------------------- - I hereby certify 4hat I have prepared this application and that the work will be"done in accordance with San Joaquin County ordinances, State law , and rules and regulations of the an Joaquin Local Health District. (Signed) ;'h� /l ------------------------------------------------ -- -_---(Owner and/or Contractor) B -•--•-. ---------------- - ---- ------- ---------------------------------------------------------------(Title)--.-- --- ------ -------- - ---- -------- (Plot an, 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-----T_,-R)_-0--------- - ------ DATE------- �� ------------------- ------ - ---------------------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------ ------ Alterations and/or recommendations:--- -------------------------------------------- ------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---------------------- FINAL INSP ------- ------ ---- Date ---------- d4 �� - ------ - -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.