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FOR OFFICE41JSE:,- ----- v APPLICATION FOR'SANT ATION PERMIT Permit No. --- -------------------=-------- - . ..,. [Complete in Duplicate) ------ ---------- ---------- Date Issued ----- ------------ �J ...._-__----------.___ This Permit Expires 1 Yea+ From Date issued Application is hereby made to-the San Joaquin Local Health Districtsfor,a permit to construct and install the work herein described. y, ante�No_ 549. 22�—OZ3-- 2!J M �/1 This application is made in compliance with Count Ordin -, �r PP 2 _ S « 11 -t ------------------------------- JOB ADDRESS AND LOCATION_'��:_J..�,I�1_I!�+_"_. ;Fl�----_--- r - - Owner's Name----------- = --------- ---------- - ------------------------------------------ L --------------------------------------- Address G� 7� _ -- ----- ---------------------- e - ------------------------------------ ------ Contractor's Name---A'1_�___{� .. - 7 i--_--- --' Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_ Number of bedrooms-3--- Number of baths __,/__ Lot size ---/,aM_--x--/,5-20-------------------- Water Supply: Public system El Community system ❑ Private �pth to Water Table _- - tt• Character of soil to a depth of 3 feet: Sand ErIGravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application l4a`d67(If yes,date--------------------) No [I New Construction: Yes R' No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if.public sewer is available within-200-feet.)n� Materia___._ lJ/�/�- �—�s� I4� R�-� Septic T k: Distance from nearest well ��_.__Distance from foundation_____ No. of compartment---------------------.. Size--- _x__ X2� Liquid depth_-_ ,_.. ------Capacity----- Q---- Disposal Field: Distance from nearestwell._..?��-_____Distance from foundation----/0------_Distance to nearest lot line�._��- ❑� Number of lines------f— ___--------------Length of each line__-h__ty-.� _ _..Width of trench_-----• - f------------- k O Type of filter material-'-? ---:-Depth of filter material-__-.-//_._---_-.Total length Seepage - -------------------- 41� fx Seepage Pit: Distance to nearest well---------------------Distance:from foundation________._ _ _______:Distance to nearest lot Gne_.---------------;. El Number of pits-- ------------------Lining -material-----------------=----Size: Diameter-------------- -------Depth-------------- ---------•--- P well from foundation-------------------.Lining material--.---------------------------------- { --. ----------------Liquid Capacity----------------------------gals. Cesspool: Distance from nearest Depth--------------------------------- - - -- Size.: Diameter----------•- ------------ --- PriJ� Distance from nearest well------------------------------------.-------- Distance from nearest building-----...__-____-._._------__.___.--------. Y GI] Distance to nearest lot Ione.------- ----------------------------------------;--------:----------------------------------------- Remodeling and/or repairing-(describe):------- .P14TIj�' 17 f L 19T� DT �Yy -------------------------- l� l'f - /_ _ -- fir' ----- g � .� = --------------------------------------------------------- ------------------------------- ' F t - --..-------- ____________________________________...--_-_.-t__-____-___._-_-__-_--_.__----.___-_-__-____--_-_--_-__-___-__-_-_1-_--__-_-_____ ___________.______________.____________________.__.___________________._ __ _ _________________________________________________•-------------"------—------------------------—--------------------------------------------------_-------------------_______.._- pplication and that.-the work will be done in accordance with San Joaquin County I hereby certify that 1 have prepared this a ordinances, State laws, an '----�.--- d rules nd regulations o .,the San Joaquin Local Health District. r 4 [Owner and Contractor) [Signed]----- � ---------- - -- - -•------ (Title)---: w[PI p n showing size of lot, location of system in relation to wells, buildings, etc:, can be placed on reverse side]. FOR DEPARTMENT USE ONLY _. r APPLICATIONACCEPTED BY --------- ---------------- ------------------- ------------------ DATE---------- ----- .,/--'.- ---I--- --- - -> DATE-- REVIEWED BY----------------- BUILDING PERMIT ISSUED--- ----- --- = ----- ------•• DATE-------------------------------------------- ---------------- Alterations and/or recommendations:-- --•-------- ------- ------5----•------ ------------------------------ ------•-----------•------------------- k ----- --------------------------------------------------------------- •------------------------------------ -------------- --------------------------------------- ----------------- ' { - --- ---------------------------------------------------------------------------------- --------------------------- ----- i - ----------------------------------------- ------------------- ----------------- ------------ ------------- J 1_L� FINALINSPEG, N BY: __ - -------- ----- - -_ 'J Date -----^�----- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelkon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street stockion,California Lodi,California Manteca,California Tracy,California t, F.P.Ca.