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FOR OFFICE USE: <br /> r2 f <br /> APPLICATION FOK""SAWITATION PERMIT Permit No. _4�-------- <br /> --------------------------------- ----—----------- - (Complete in Duplicate) <br /> ----------------------- --- --- --- ---------------- This Permit Expires I Year From Date Issued Date Issued ----------------------- <br /> I.—' <br /> Application' is hereby made to the Son-Joequin Local Health Dist rict for a permit to construct and install the work herein described. <br /> This application is 'made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS ANR_LqCAPOIN�---------- <br /> --------------------------- .... ------------ -------------------------------- <br /> - ------- ------------ <br /> Owner's Name------ 4/� __ � ---- <br /> a1 .. 1�--------------- -------------.... Phone------------------------s <br /> ----- ----Address-- ------ -- - - ------------------------------------------- ----------- <br /> ------- ------------------------------------ ------ Phone <br /> X <br /> Contractor's Name--------•-•---l <br /> ame--------------/ j ............. ------ ---�7__", ­-------------- -----------------------------...... <br /> Installation will serve- Residence t- Apartment H6use­''[' ],,CdmmerciaI �E] iler Court4�0' eI" <br /> Mot 0%' Ll <br /> F <br /> Lot size __-_---___'°________________________________________________- <br /> 'Num Fs 7!7' <br /> Number of living units: J.-I Number of bedrooms <br /> Water Supply: Public system Frl�Community system El Private Fj,,.,-Depth to Water Table - <br /> Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loom El Clay Loam E] Clay 0 Adobe [] Hardpan ❑ <br /> -T-— <br /> Previous Application Made: (If yes,dote--------------------1 No E] i New Construction: Yes 9Q Ll FHA/VA: Yes E] No 2— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p� Distancefomfondalo _Aa <br /> sewer is available within ofSeptic <br /> TankDtancefrom nearest wel - -----------M a f e r i a 1 4--- ---------------- <br /> ap <br /> No. of compahmerils--A-------I---------:Siz,�M6-------Axd_Liquid depth-- .2................G acit -------- <br /> i - � .1. A - y <br /> ------Disfanc6 from found -----Distance to nearest lot line-07 <br /> Disposal Field: Distance from nearest well -------- ---------------- \1 <br /> ------------- <br /> Njmher� of lines--------/----- Length of each line- ----Width'of-"f�eln�th� <br /> Type of filter material Depth of filter material-_ZY- -------Total lengfh--3P- ----------------------------- <br /> Seepage Distance to nearest well-------—__-_-__Distance J. om fof�n�Otion---- ---.Distance to nearest lot line. <br /> Number of pits...... --------------Lining material-- Size; Diamefer__3_ _.'.11-------Dept h.... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------- ----------1ining material________________________-_______-_._. <br /> ❑ Size: <br /> aterialz----- --------------------- <br /> Size! Diameter------ --------------------- - ------ Depth------------------------------------------------ ---Liquid Capacity----------------------------gals. <br /> Privy. Distance fromi nearest well-------------_---------------------------------Dis+arce from nearest building__-----______________________"-_-.__..._. <br /> F1Distance to nearest lot line------------------------ ---- - -------- ----------------------- --------------------------------------------------------------------- <br /> , <br /> I <br /> Remodeiing and/or repa�6ng (describe):--------- ------ —-------- <br /> ----------------------------------•-•-"------• <br /> ------------------------------------ <br /> ---------------------- ---------------------- -- --------------------- -------------------------- --------------------------------------------------- ---------- <br /> - I I <br /> -------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- - ---- <br /> I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and re cations of the San Joaquin Local Health District. <br /> (Signed)----------------------------------------; ----- --- - --------- -- --- -- -------------- -- ------------------------------------------- Contractor) <br /> By:----------------------------------------- ---------------- <br /> ------------------------------------ ------ _(TitIL <br /> (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B AIIA-e--------------------------------------------------------------- DATE------ <br /> ---------- -- --------------------------- ---- <br /> REVIEWEDBY---------------------- --------------------------------------------------- ------------------------------------------ DATE-------------------------------------------- --------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------- -------------------------- ------------------------------ DATE---"------------------------------------------------------- <br /> Alterations and/or recommendations:--------- -------- ---------- --- -- - ------ ------------------------------------------------------------- ------------------ ------------------------------- <br /> --------------------------------- - - - -- - -----------------------L---------------------------------------------------------------------------------------- --------------------- -------------------------- <br /> -------------------------------------------------------------------------- -------------------------------------------------------__----­------------------------------- ------------------------------------ <br /> ----------------------------------- ----------- --------------------------------------------------- ---------------------- ------------------- --- ------ - ------------- -------------------------------------- <br /> - ------------ ................................. ----------------------------- ------------------- ---------- ------------------------------------------ -------------------------------------------------------------------- <br /> FINAL INSPECTION BY ----- - ---- ------- Date-----------. -- - -- ---- ---- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod!,California Manteca,California Tracy,California <br /> 4 <br />