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=0111C USE: '^'" i Permit No." �p;3a "" APPLICATION FOR SAWATION PERMIT-- ----------- ------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued r Application is hereby made to the San Joaquin LocaOrdinance aghDlNoG f or a permit to construct and install the work herein described. This application is made in compliance with County 9. i� l\_ ��ni •------------------------- ---•---•----- -----------•- ----------------------- JOB ADDRESS AND �QCATION Phone-4a-_4 �"------ --------------- Owner's Name Address-------- on Contractor's Name________________ ___ _ qMotel Other [IInstallation will serve: Residence 0---Apartment House E] Commercial ❑ Trailer Court ❑ ❑ --- "-- Number of baths __%--- Lot size ----�+.�--�--?��--•-----------•---•-"" --- Number of living units: ___�__ Number of bedrooms - � ------ Depth to Water Table __..____ ft. F Water Supply: Public system D�Community system ❑ Private ❑ p Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam ❑"Clay ❑ Adobe❑ Hardpan C] 1 - No FHA/VA: Yes E] No p- Previous Application Made: (If yes,date----------- --- -I No ❑' i i Construction:� Yes R ❑ I. 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_-------�e th-"Material_-------- Capacity------------------- No. _____.. ____ __. ❑ No. of compar#menu--------------------- ----Size- --------------- ---------=- q p Ilk I Disp sal Field: Distance from nearest well-._-._.--"-=Distance from foundation__ Q-------- Distance to nearest lot lirle�_^a f -Length of each line-_-_ Width of trench..._..-��---------- ❑�_ ber of lines % 9 Type er filter material__-3��-c°�°1E�---Depth of filter material-_-� ------------Total length--.--__ '_� ----- Num \ ' _ Distance to nearest lot line- ----• �( Seepage�P•st: Distance to nearest well------ -----------Distance fr foundation.__a� _-- ® Number of pits------/------------Lining material-_-/ Size: Diameter__. %. ---- ---Depth._-_r '. -- f Cesspoo$: Distance from nearest well-----------------D'sstance from foundation------------ -'---- nmaterial ------ - ------- -----gals. --Depth------- --------- -------- -------- --------------- Liquid Capacity y--------------------------- ❑ Size: Diameter___-------------------- ------ - Distance from nearest building___ -—----------------------- ------- Privy: Distance from.nearest well -_ ;;.__ _ r_ �..... .... ------------------------------- pistance to nearest lot lire.-------.-------- ----- ------------ ..�,. - - I Remodeling and/or repairing .(describe):--- - --- -- 1-._ ------------------------- __ ------------- ------------------------------------------------------------ I P j - ----- - -- --------------------------------------------- -- -- -- hereby certify that I have prepared+his pplicattion and that the work will be donein:accordance with San Joaquin County ordinances, State laws, and rules and regulations oof he San Joaquin Local Health District. 7fwn fan d/or Contractor) Si ned -- ------ ---------- ------------------------------( 9 ] •`- ��Q�__�t.rx--.--�_�--------------- (Title)-- -- ------ -- BY'-------------- F v / (Plot plan, showing size cf la location of syr}em in relation'to wells, ; uildings, etc., can be placed on reverse side]. FOR DEPARTMENT)USE ONLY I I � DATE------ __� -f. ------------------ APPLICATION ACCEPTED BY--- ------ --- - ----------- DATE-------- ------------------------------------------------- REVIEWED ----------------- ------------------------ REVIEWEDBY---------------------------------- --------- ---------------------------------- ---------------------- DATE---------------------------------------- -------------------- BUILDING PERMIT ISSUE ------------------- --- -------- - --- -- -----`-"---- G , Alterations and/or recommendations:------�!' - ------------ ---------__--- _-. - ---------- ----------------- ------- ------- --- -- li t < ---------------- = ------ ----------- --------- ---------------------- ----------------------------- � ox -------------------------------------- FINAL -- --- ---- ------ - FINAL INSPECTION BY--------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California