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FOR OFFICE 11SE: -----------------__"._-.---_----- ------------------ APPLICATION FOR dSA-NITATION PERMIT Permit No. ------------------------- - --- --------- [Complete-in Duplicate) �- ------------------ This Permit Expires 1 Year From Date Issued 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. -scA�D� 3 - . S / / W JOB ADDRESS AND LOCATIO _,�'L1?�---�(.fr_�__4�IVj�--- --10-�'-`----- --�F----�f G7-Q�-�y---RP._..- -'":=------------- Owner's Name____ __!I- { Qs 1 Q - Phone �v -11 __�__ -__... a `�- - q2---------OIMI Ian �-----------------• Address..........RTF -------- -------------------------•------•-------•� ,-" ~ Contractor's Name...QW --------------------- ----------------- ----- ------- ----------------------------------------------- Phone------ •--------•------ Installation will serve: Residence (Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ 'l Number of living units: -1----- Number of bedrooms __Number of baths-1------ Lot size ----- IC - - -----.__.__"._.-_._-__._...-_ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table-1sft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: [If yes,date---------- ] NoNew Construction: Yes ❑ No Ql"FHA/VA: Yes ❑ No1 TYPE OF INSTALLATION AND SPECIFICATIONS: [No er septic tank or cesspool permitted if public sewer is available within.200 feet.] Septic Tank: Distance from nearest well-------- ------Distance from foundation-------------------Material """" ............ E)Q&TlP4& No. of compartments------------ ---- -- -----Size-------------=------ -----------Liquid depth--------- -- - - --------Capacity----- ----------------- Disposal Field:, Distance from nearest well__? ...Distance from foundation.._JP-----------Distance to nearest lot line__5—------ F- STIN Number of lines__________I------:.__... --- "---Len Length of each line------"- ® � --------- Type " Jc g °�- - Width of trench y Type of filter material_ _�'C -----Depth. of filter material_"__.--1_'_-r_....Total length"""----__."_•+ ____ Seepage Pit: Distance to nearest welt-.---/0-0-----_-Distance from foundation-----to-------_. isfan e to nearest IIof line---_� H W; Number of pits.". __1_.............Lining material j?CCA-.__ Size: Diameter-_ X__V...._ Depth_......[`----___-_----- ` Cesspool: Distance from nearest well --------- _.Distance from foundation................. ..Lining material------------------------..___.__-__.-. ❑ Size: Diameter- -- - ------- ----- ----------------Depth------------------------ ------------- --- ------Liquid Capacity-.--------------------------gals. �. Privy: Distance from nearest well------.------------------... -.----.....Distance from nearest building._-------------------------------- ❑ Distance to nearest lot line ..----------- - - -------------------------------------------•------ Remodeling and/or repairing (describe) ' 'D' - .--6773!47------------------- r . ------- -------------- -------------------------------------------------------------- -•------------------------------- -----------------•------------------------------------------------ - ---------------------------- 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. I ------------------------------ - -- -------- - -- -------- -- - --------------------- -----------(Owner and/or Contractor) y:------ --------------•---------- -------------•--------------------- ---- --------- ------ --- -----------------__---- --------(Title)----------------- --------------- - -------- -------- [Plot plan, showing size of lot, location of system in relation �}wells, buildings, etc., can be placed on reverse side). FOR DE RTMENT USE ONLYAPPLI ; Y CATION ACCEPTED BY - ---------- --------------------------- DATE....... ------- -------- REVIEWEDBY------- --------------------------- -------------------------------- ------- ---------- --------------------------- DATE BUILDING PERMIT ISSUED_------- -- ----------------------------- DATE-------------------------------- Alterations and/or recommendations:...._ _/_NT,r1 ._.__Dl.. .._./1fG .__.� L?L_RST��111' .__"`�tNpTT._.- _-"-"(�If -s-"--"""" lAt. ------.. F+-^f R 4- 1JV - -��-n,� -...... f9X5-------=�8,114r v�/►4s. 5-� � p :t4 f-J_�_��vnl -----�S.-------�+/.Q.f 14tn� I� -t "FEcT 11[C . 51 GAN f --- --•------------------- --- ----------.. ............. ..-- - ------ - ------- ---- ------ ------------------- -- ---------------------------- -------------- ------ FINAL INSP = Date------ - - ------- SAN -----SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.hla:ellon Ave. 300 West-Oak Street 124 Sycamore Street 205 West 9th Street 4 i Stockton,California Lodi, California Manteca,California Tracy,California E.M.9 2M 1.67 Vanguard Press +