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. APPLICATION FOR SAKI r ATION PERMIT Permit No. 1 , (Completc: licate) i ti( .f L'� I- Date Issued0 --1_�, ~ s - - 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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.._._ l ------------- Owner's Name__ 1t�---kA ------------------------- l yv� Phone------------------------------------ Address-_-__- $L�__ ' t --- ------------------ Contractor's Name - ----------------•----------------------------------------------:------------: ------------------- Phone.----•-':---- Installation will serve: Residence ®-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑\ Other ❑ Number of living units: _-2.. Number of bedrooms .__�_- Number of baths Lot size __qqA2 _4__`Z/__K�_ Water Supply: Public system El Community system El Private [Depth to Water Table Sao- ft, .� Character of soil Ifo a depth of 3 feet: Sand [3Gravel ❑ Sandy Loam❑ Clay Loam E] Clay ❑ Adobe El-lI-tardpan ❑ Previous Application Made: Ilf yes,da#e ---_------_--------a No El"" New Construction: Yes Pn""No ❑ FHA/VA: Yes [] No a" {I TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well-0Q.''-___Disfance from foundation__v2o-�____.Material___W-4--41101W [ �r:►" '�No..of compartments Size-_ _ _ '?S_ -------- P -----�---- - - - Liquid depth------9- -------------Capacity---/4.�p.. Disposal Field: Distance from nearest well P_1-____Distance from foundation_.-_-_.---.-.Distance to nearest lot line_.- -- Number of lines_---_3-------------------------Length of each hne_/do_-`_-----------------Width of trench__A_!r__`!___ Type of filter mater ial'FP_G-k---------Depth of filter MateriaL__Z$'``._.._-____Total length----- ----- _-7._!___ r i Seepage Pit: . Distance to nearesf well. /00_�_ Dist ante from foundation__-p------±__..Distance to nearest lot line---%5 _�_.___ 4 ©� Number of Pits--- _ -W --Lining material_76c� # Diameter_---- -.-.--. Depth- . ...Z_0:7_----------_--- - - ------ Cesspool: Distance from nearest well----------------- _Distance from foundation___----_------------Lining material_-.-.-____---______._--___.___-_.__-. ❑ Size: Diameter I----- ----- - --- -----Depth-----------------R-------------------------------Liquid Capacity- --------------gals. Privy: Distance from nearest well______________________________.___._._.____.'__ Distance from nearest building-------------------------------._.._----. ❑ Distance to nearestlo+ line - ---------------------------------------------------`------------------------------------------ Remodeling and/or repairing (describe):------------------------------------- ----------------------------•------------------ -----•---------------•-------------------------------------•------------------------..-..-------7--------------------------------'-----------------------------------------------------------------------------'------------_.-- I ------------------------ -----------------------------------------=------------------- ------------------------------------------------- -------------------------------------------------- - Il --- -------------•--------------------------------------------•-------------------.- ---- ----._._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and ruI s d re lotions of the San Joaquin Local Health District. f 1r s (Signed) -- = [ --------- - --- - ------------------------------------------------------------------------ ---------(Owner and/or Contractor) By:----------------------------------------- ----•-----------------------------------------------------------------------------------(Title)----- ---r--------- --------- ----.------------- ------ } (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----�-� F �/ ......... M--- -------•------------------ I-- -�----�--------------- --- - . .. DATE.______-�y--��-��-5~-------------------- , REVIEWED BY-------------- -- BUILDING PERMIT ISSUED —------ ----- ;------- DATE Alterations and or recommendations:. =_ _f '`�_ ._ K . ��—t�� --="�=---- � -- ------ -- ------------ •- ----------- ---------------------------------------------------------------- ---- ---' ---------------------------------- ------------------------------- '" FINAL INSPECTION BY:------- ---- Date / . / --------------------------, SAN JOAQUIN LOCAL HEALTH DISTRICT } 1601 E.Ho Zoltan Ave. 300 West Oak Street 24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California k ,