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FOR OFFICE USE: ..F............... ----------------- ---------- APPLICATION FOR SANK, `ATION PERMIT Permit No. _1f,_7 - ---------------------- - --- -- -- --- ----- --- This Permit Expires 1 Year Date Is (Complete p Date Issued /? - ------------- ------- -- --------- - -- - - -- p- sued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliant with C unty Ordinance No: 549. Zp(._�'p_pwro -rLf� s�1 -�`7 JOB ADDRESS AND LOCATION___��AL --------I--J" _ `51LC•}TT------ n -- -•-!hir__. .------ / �'.H_... P---. -- -n . Owner's Name------------ //_ _E. T- ---------=-HIT H—CaC K '-------- --1-----------.......... Phone------------------------------------ —----------Sax---------J3. - -- -------------- Address_----------- ------------------ Contractor's Name-----i(2_VU[VaR--------------------------------------------------•--------------------------------- ------ Phone---------•-•-----------.----------- Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __�_____ Number of bedrooms _2—Number of baths -------- Lot size __, _ _ ----------------------- Water Supply: Public system ❑ Community system ❑ Private [Zr Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ,[r`f New Construction: Yes ❑ No �FHA/VA: Yes ❑ No E _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic lank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.._-_�.__Q-__Distance from foundation____/ -------Material--- r, l� No. of compartments-----_.___,=___.._.__Size__5._X__9_._�S_=_Liquid depth------ Capacity______ ___�_�_----____ Disposal Field: Distance from nearest well.__.,Jr©-----Distance from•foundatio ---/0------.Distance to nearest lot line... .......... Number of lines---------- ---------------_------Length of each line_____ ___`________.Width of trench-__-------4�6--- rr 09 Type of filter material----fl.Q_C__KDepth of filter material--------/3--------Total length_____________ _____--__________ Seepage Pit: Distance to nearest well____f0_0Distance from foundatic,___J__0--------DistanC rto nearest lot line__._ ____ ` u Number of pits.....(----------- ---Lin ng material_ �_C.K---Size: Diameter- -k----- -----Depth--------_ _-- ---------___--- y Cesspool: f t Distance from nearest well-----------------Distance from foundation__ -----------------Lining material__.._..__________________.._______ ❑ i Size: Diameter Y-1--------- --- Depth, , - Liquid Capacity gals. Privy: Distance from nearest well--------------- ______________. _..._____. __..Distance from nearest building ler ❑ Distance to nearest lot 1ine---------------------------- ------e------- ----A------------------------------------------ ------------ ---- - -------- ----------- Remodeling and/or repairing (describe):------ > FaL- -- -----jEX_j ST�_/1t-:7 ------rte �_M------------------------------------------------------- --------------------------------------------------------------------------Mt.0_,-D--=------ -- ------------------- --- ------- ---------------------------------------------------------------------------- ----------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---- ------------------------ -----------------------------------------------------------------------------••--------------------- ----------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules, and regulations o th an Joaquin Local Health District. I (Signed) f = �'----- ---- ----- � ,f------------------------------------------- ---------- ------------------------(Owner and/or Contractor).- By:--- ontractor).-By:--------------------------------------------------------------------------------------------------------------------- -------------(Title)-------------------------------------..._....-- ---- --------- (Plot plan, 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 - ----- --------------------------------------------------------- DATE----------10----h3-------675�77----------- REVIEWED BY--------------------------------------------- --------------------------- ---- ------- -------------------------------------- DATE----------------------- ----------------------------------- BUILDINGPERMIT ISSUED ---------- ------------ ---------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations-------- ------------------------ ------------------- ------------------------------------------------------------------------------------•------------------- ------------------------------------------------------------------------------------ ---------------- •----------------------------------------------------------------------•--- ------------------------------------------- ------------------ ----------------- ------------------- ----- ------------------------------------ ---------------------------------------------------------F-- ---- ---- ------------------------ --- - ----------------------- ---------------- `-------- ---._. ..._. --- ._:-� -I-------------------------------------•------------------------------------------.. ------------------------------ FINAL iNSPECTION_BY•.... '--- ---_ - - -- -- - - ------- Date------------------- -------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasslton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California .. F.P.0 a.