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FOR OFFICE USE: --------- --- - -------------------- J _______ _ ---//"00----------- APPLICATION FOk SAWATION PERMIT Permit No. /__�l- ---------------------------------------- --- -- -- --- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued ------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and inshall the work herein described. This application is made in compliance with/County Ordinance No. 549. JOB ADDRESS AND LO/C/�� ISO,N- l-2 Owner's Name--------------- -�/ ------ - ----- '- --------------------- Phone---� Address =l-1 r --- - ,- - - ----------1/-- ----- �-' 1 —�a Contractor's Name------- �� ---•---- ---- -- ---�`------- -- ��----------------------------------------------- Phone----------------------------------- Installation will serve: Residence --Apartment House F I Commercial ❑ Trailer Court ❑ Motel ❑ Other/❑ Number of living units: f----- Number of bedroomsumber of baths _/__ Lot size ------lam , s ---_-________.____ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table -ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan ❑ Previous Application Made: (If yes,date. -- --------_) No �ew Construction: Yes ❑ NoA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se •c ank:_ Distance from nearest well-___._..__.___Distance from foundation----_- .-___-___._.Material_____________________-.-_-__-____..____----_--_ �� No. of compartments----- --------------------Size--------------------------------Liquid depth--------------------------Capacity-•-------------------- Disposal Field: �Uistance from nearest we31_ Distance from foundation___ __ _____ _____Distance to nearest lot line________. Number of lines--------/___._._�______. _____Length of each line_!_ l ______-_---Width of trench---c�_�.r/___________- otal len th------� !--------- � Type of filter material -1-/ _� c�x'Depth of filter m r'al —� g 4 Seepage Pit. Distance to nearest .eff_____..._`___ ____Distance f foundation___ ______ Distance to nearest to iine__�,_-__ Number of pits___-.__....._---Lining material-__ .Size: Diameter..a__-��__-/_jr-__--Deptn___�s � --- ---- -------- Cesspool: Distance from nearest well-----------------Distance,from foundation----------------....Lining material---------------------_--------------- _______________________Liquid Ca acit gals. - ❑ � Size: Diameter- ------------ -- ---------------Depth--------- - --- ---------- q p Y -------------------------9 . Privy: Distance from nearest well___---___---___----------------------------------Distance from nearest building---------------------------------------._. Distance to nearest line------------------ --- ---------- Q ---- ---- = ------------------------------ ------------- -------------------------------------- - F. r "Remodeling and/or repairing Idescribe):--------------------- ` --------- ------------------------------------ --------•------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ - --------------------------------- ----------------------------------------------------------------•------------------------------------------------- --------------------------------------------------- ----- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ules and reg o the San Joaquin Local Health District. (Signed) = ------ --- --�fll-, (Owner and/or Contr --------------------- actor) ------- By:----------- -------------- -------- ---------------------------------(Title)---- ------ (Plot plan, showing size I , location of system in relation buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -- --------------------------------------- DATE_- �Q-3J-�6 -------- -- -------------------------------------- - REVIEWED BY-------------------- ------------------------ DATE------------ ---------------PERMIT ISSUED - DATE-- ------------------------------------------------ Alterations and/or recommendations:_ -------------------------------------------------------------- -� ---- --------��=--------------------- /---°-`-----t------------------- ----------------------------------------------------------- ------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY .... _ -. . ---------------- Date--------------//-./� ! 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 i.P.C Q.