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FOR OFFICE USE; ___ --- - .._--------- APPLICATION FOR s$AAIfTATEON PERMIT Permit No. .l2.r�'_ ................... -------------------- ----- --------- (Complete-in Duplicate) �f Id,/ _-..._. This Permit Expires 1 Year From Date Issued Datessue ___f.... --- 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. JOB ADDRESS AND LOCATION_.- - _;r0 ----- r----------- --- ---6 c Owner's Name__ ------ --------------------- Phon4o57 � e Addres _ /- .---- --------- 1� .......... Contractor's Name--- ---- ----*_ -- ---- ----- -----------------------------------------•----- Phone-_4 (PfiO4'2_ Installation will serve: esidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ I-_._ Number of bedrooms _._Number of baths__1.____ Lot size ---.--_----- ------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 757 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date------------------- ) No K New Construction: Yes ❑ No)<L_ FHA/VA: Yes ❑ NoT 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-----------------Distance from foundation-------------------Material ---------------------..._-----------..---_____._. ❑6744t54tN(; No. of compartments-------------------------Size---------------- -- -----------Liquid depth--------- ------- --- --- Capacity------------------- Disposal Field: Distance from nearest well z(.7�Distance from foundation_ _ _ \ 1.............Distance to nearest lot line_5 Number of knes._0 ... Length of each line__„'1.0._-Y___--_- Width of trench._2 Type of filter material____ _ __ ____ _______Depth of {liter material____._ _��________.Total length_._.-340--'* ------------------------- Seepage -____.___________._____ � a Seepage Pit: Distance to nearest well_- 10l✓___Distance m f ndation--1Q__�__.Distan�e to nearest lot �, Number of pits__. _____...Lining material Size: Diameter__ - _._Qf__Depth---- .. _c..:.......... Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material----------------------------•--___.__ 0 ❑ Size: Diameter- -- -------- ----- ----------------Depth------ -----.....-- --------- - - ----------------Liquid Capacity. -------------------------gals. Privy: Distance from nearest well .................._---_--.--_.__--- -------._Distance from nearest building--------------------------------------.._. ❑ Distance to nearest lo+ line ----------- VVV n Remodeling and/or repairing (describe):----- ----- --- •--- . r --------------------------------------------- ----- -------------------------I------------------- -------- ------------------------------------------------ ----- ------------------•------------------------------- ------------•--- ---------------I---- ------ I hereby certify that a e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d ru sand regulat' .ns of the SoJoaqLocal Health District. (Signed) ------------------ --------- --- ------ - .._.._.(Owner and/or Contractor) By:----•----------------- ----- (Title} `- (Plot plan, showing size o of, location of system in relation , uildings, etc., can be platon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-It'!---- Y-- t'!---- ------------ -- ----------------------------------------------------------- DATE- REVIEWEDBY------------------------------------------ -- ------------ ----------------------------------•------------------------- ------ DATE------- BUILDING PERMIT ISSUED--------- ------------------------- --------------------------------------------------- --------- DATE.--------- Alterations and/or recommendations:--..... ........ ... ._,..._.._ fl.; q ______.__ - .--'L!-- ---Iss�_1 '`'fir�JIC�'t.�G� _..._ L�/ BY:.. = ti v Date G------ ---- ---------------- FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press