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FOR OFFICE USE: :. .......... ... .. ... ... ... . . .... r Permit No. ...�rpf`� APPLICATION FOR SANiTA.ION PERM .. ,. ..... , (Complete in Duplicate) Date Issued .. •.� This Permit Expires 1 Year From Data Issued tir Application ;s h7reby meds to the San Joaquin Local He alfh District for a permit Jo construct and in the work herein described. This application is made in compliance with ounty Ordinance No. S49. J08 ADDRE /S`AAO ATION.__.k.../.. .. . �'•--•--"••�� Owner's Name Name............=-- . ��......"�.`.. T.T,If...�•�5........... ............. ......................... Phone-.'gam to ....... ...�!... r 9 - Address................... � �,0....... s � .. . lT ............... .... ............/ ... t Contractors Name.....:J.1. �" f 5 .._. ._�C..e.......................................................... . .......... Phone.. Installation wilt serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living un;fs: ...62. Number of bedrooms.�'._. Number of baths ..,7-- Lot size ....ITG,/C."e Water Supply: Public system ❑ Community system ❑ Private UI-6epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel [jSandy LoamCley Loam F1 Clay❑ Adobe❑ Hardpan[) Previous Application Made: (if yes,date 1 No 01' New Corrstrucfion: Yes ❑ No Ca- FHA/VA: Yes❑ No TYPE OF INSTALLAZION AND SPECIFICATIONS: (No septic tank or cesspool permifted it public sewer is available within 200 feet.) Septic Tank: Distance f om nearest well...............Distance from foundation...................Material.................................,................ ❑ No. of compartments.......... ...... ....Size----1........................Liquid depth.................---- Capacity..............—.- Disposal Field: Di;fence from nearest well ...-..........Distance from foundation....................Distance to nearest lot line..............-. ❑ Number of €fines................. .... - ........Length of each line............................W;dth of trench................................. + Seepage Pit: Distance to nearest woil _ ...Depth of filter mnicr;etl.............�.-.....Tota! length.......................................... J Type or filter materiel..... _ .D;stance 3rpm founda7ion. `2..__.....D;stance to nearest lot Line....,....__...--• r Number of pts........ ........Lining rnatenol..✓. �itY. ...Size: D;ameter.. -: .�1.. Depth...-......: Cesspool- Distance from nearest well. .............Distance from foundation.•, ............ fining material.............: T ; ❑ Size: D;ameter-..... ..... ..............Depth...._..............._._............. ........ 'Liquid Capacity.............................gals. Privy: D;stent,- from nearest well.. .........................................D^:lance from nearest bu;Id;ng._._.._._............................... ❑ D:sfence to nearest lot lane. ...... ........... . ... ... ......... ............................................_.......----........- . Remodeling and/or repair;ng (describe)%. ..,��...'.�........ .............. .. ........................................I............ .............................---..................... .................................. ..............................................................................................................-......................................I.........I.............. ... I F,•_reby certify That I have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State Id rules and regulations of the Sen Joaquin Local Health District. end (Signed) /.-..�h .- /✓ '•............................... ......Title �!:Jx- ..I.. ../ ,-tor) �1:<'�s ~�� can be(Title) an reverse side). or antra By:..........,J - ��. . y� (Plot plan, showing size of lot, location/of system In relafion to wells, bwldintls, etc., p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �. ........... ........... ..... DATE..... REVIEWEDBY.. .. .......... ..... ....... ........- .....- DATE..... ........................._................_........... BUILDINGPERMIT ISSUED.................. . .._ .. .. ...... .._.., . .........-.. . -.._.. ........ DAME..........- ................_.................._-_..--: Alterations and/or recommendations:.. .......... ..^.......I............................................... ..f....,_... ��z ...<.r-.._..T.•.r� ... .......Iy......-.......... ....-.............. ........................ ............. .......`L-r....... .......... o r _ lI!J ) _✓1 Dere. Z., .... . ........... rIIJAL .NS.ECT}O.tB 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 16C 1 E.4arollen Are. 300 West Oo4 Street 174 Sy<amcre Street 205 Wev 9th street sfockten,CaElfomia LoH�,California Manta<o,Ccl:Fornlo Tracy,California