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i T, R ONCE llsE 73 � APPLICATION ..FOR. SANT .... TATION PERMIT Permit No. .. `!- `.'. ............................................... (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 per it to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. k/.1F.s7 0.4 FLOOQ T2�. JOB ADDRESS AND LOCATION.. kSTc`/CN /t � •7rS_-•_ 2•A. • �/olelll •slpQ •••---CT�iL_e5/a . Owner's Name.......�.!►.1Z_.__..��..: f D ! �........... I�lpYt'r1C'e .../''�T24`'L.r ... Phone ................................. Address_.__.._.. Z3 ........... o-........ l:.t_.N_. ............................. Contractor's Name........ .�._Y' 5. ..7. ��'_e_v- Installation will serve: Residence ❑ Apartment Nouse ❑ Commercial ❑ Trailer iCourt ❑ Motel ❑ Other W Number of living units: __L.___ Number of bedrooms Number of baths ...f.._. Lot size .:.....`4 _.. Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table _c'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....................I No'� New Construction: Yes N No ❑ FHA/VA: Yes ❑ No�' 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.-l.P.Q.......Distance from foundation....)p..._._.__.Material.-_I1 &A,( No. of compartments....___..._�— --•---------------- .__._..._Size_�_-K_,S. `7 -X _--.........Liquid depth__-_-`I j. .-____....Capacity_. ._�?a__0.. Disposal Field: Distance from nearest well_10..0.' ..Distance from foundation.... o'_.......Distance to nearest lot line... LpLc�c� Number of lines.............I.....................Length of each Zine........ .Z'-.,,.....-.__..-Width of trench------------2.-r`i4-.�----._.._.. S Type of filter material_,Sl. crr ..___ADepth of filter material.......1_9" -------Total length-•---------------------------------�...... + I Seepage it: . - _ Depth ..._!..-._ rd Distance to nearestwell.... t...__..__ _- t. -. .__..-. ....... Numberf4 ckW Linrc'niatenaLSS_t� 4_--Size: Diameter.-------3 -------De th---------- ........ j Cesspool: Distance from "nearest from foundation....................Lining material.............................-........ ❑ Size: Diameter........................-............!Dept..............................................._..__Liquid Capacity................... --------gals. 15 Privy: Distance from nearest well________________ ......................Distance from nearest building.............--........................... 4� ❑ Distance to nearest lot line......................... Remodeling and/or repairing (describe):....___l.b�s�T.}`� �7.._ ..........5.t•:�-.S. �. tr- r{C:4 ti E" 'ScJr Gi t.:.... ........................................................... -------------------------- -------- - :°....................... ....................................-...................................................................................•......... Sl 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, and rules and regulations of the San Joaquin Local Health District. 1 � (Signed) _ _ _---_ . .... .. ....... r n -. ........:...._..-..-..-.__......._....---._._..._... . ------•- Owand or Contractor) (Title)- (Plot plan, showing size of lot, location of sys em in relation to wells,rbuildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.......... f ------------------------------------------------•--------------------------- DATE----- *'._-�'. ._ ------ REVIEWEDBY------------------------------------------------------------------ •--.----_.-..___---._---------•--•-_-------....__..._...._. DATE..._---•._.._......._._....------------.--- BUILDINGPERMIT ISSUED...............•----------------...-------•--...-----•--•._._---------------------------------------- DATE................................................... Alterations ye �ommendetions:._._....__•___-___-_- -•-- •..............•--... ...................• ._.__.___-_'. ' J �._._.r 'l�r .. .............................-----------------------•---------_-___-___----_____----_-_--_ .: ... i FINAt INSPECTION BY:............... �.... . • ................... Date........ � :�.. .-........-..-.. SAN JOAQUIN LOCAL HEALTHDISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycainore Street 205 West 4th Street i Stockton,California Lodi,California Manteca,California Tracy,California •,• F.P.0 O. I