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FOR OFFI..0 USE/ _ ---APPLICATION FOR SAIT,p►TION PERMIT41 Permit No. � �-•-- �/ ]l - ' Com lete to Duplicate) 1 PDate Issued'._.. -------63___ _.. - this Permit Expires 1 Year From Date Issued i Applic ion is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r" JOS ADDRESS AND LOCA * Owner's Name_.-.-------- ---- •--•--- ------------------------------------------------- ----------------- • ...n.le•d-.�....-- I ' --------- 1 -- i 1& - 7 �I 16 t 1 r ------ .Address-------------------• ..-- Phone......� - -. .......... Con#rector's Name..............-----------------------------•-------------------•-••---•----••-•----------......----•----•- Installation will serve: Residence vi Apartment'H e ❑ o mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f 1 / Number of living units: _1.... Number of bedrooms .a- / .....••••••--- _._ -..umber of baths ___ ... Lot size .___..-.�____.__ Water Supply: Public system 2 Community. system.C3Private [j ' Depth to Water Table .i____ _ ft. Character of soil to a depth of 3 feet: Sand ElGra el" ❑ Sandy Loam❑ Clay Loam 0 Clay.❑,„,,.Adobe Hardpan ❑ Previous Application Made: (if yes,date---------.--------:__I No ❑ New.Construction. Yes ❑ No)K FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ! 1 (No septic tank or cesspool ptirmitFed:if public sewer is available within 200 feet.) r Ott f Septic Tank: + Distance from nearest well __r______Distanc? from} foundation_ a ' � -- �---��"t.�, _.Material-------------------t---•--t-----._...............' No. of compartments.._...__ '_ '_ Size...._..r - - .._a=_Liquid depth______�f" .._--------Capacity.... -. }Distance from foundation .ZZ,4, Distance to nearestof ling.__a_hk IA Disposal Fi?ld Distancefrom nearest/w 11.:= ___. _.. . ,`F-7_- l__.Width-cf tren !?. Length of each-line..____:__;�l�,' Type-of filter m terial -- p#iof filter materiaL�z] . __Total length..____:.-_- .�_ ._-- A-___ Seepage Pit: Distance neare�s�well -__Linin mDatstance f o Sfoun ation _:„?fid- -..fDist�a/nce�o nearest lot fine ___.{?7 ' lT' N' y - �-y,Ii g Number of pits---- g erialr�, Size:_Diameter.---![�_.�1-�J.__--Depth-- ------------ Cesspo O 4M ' Distance-4rom'nearest well-----------------Distance from foundation.-_-----------.-----Lining material------------------------------------- ❑ Size: Diameter-:-------------------------------------Depth-._'_-----------------------------------------------Liquid Capacity 9afs. Privy: Distance from nearest well-____, _;__- =_y :_._{_.._ _-___---__.._Distance from nearest building_____________________ ❑ ........ -------•--------- •-----------•- + -----_ -------------- - -- Distance fb nearest lot line_..=' - ' t Remodeling a reparng,(ds � = r'' z ! r •.- r l __.__{.�.<_~__�_�__ �rfii-' -•'M-Gam'-__ _ __ -.._"__ __ ____. _ ___._.__ __ ____........._...___ , j. 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 t San Joaquin Local Health District. s� f f 1 (Owner and/or Contra, l' (Signed)••--•-- •-----• i 1 ! w i Title ( , gY: ----------- ....... ........------•-----•-------------- -------•--.--•------- ( ) ,;� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on,Jreverse''side). w FOR DEPARTMENT USE NLY APPLICATION(ACCEPTED SY M ----- DATE T ------ REVIEWEDBY-------------- •-------------•---.._.;_...__.----------------- ---•• - :.. BUILDING PERMIT ISSUED__::`----`:._ ----- �� ¢ .._._l :_ --------- D,4TE Alterations and/or recommendatto �- :- --`�•---------------------- ----=--- --- ---- r �v. .. b c� -- ------••------------•-----------• ••------•-_-- . ---•------•-------. —I = -------••----------••--------------------------•---.:.- L __ ----_______________________________________________... ...............____________________________________ e_ � t•- 5 FINAL INSPECTION BY:_ ..... - ------ - Date---- ------- ------------ SAN J AQUIN OCAL HEALTH DISTRIC ! 130 South American Street 300 VY to Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Locil,California - - Manteca,California Tracy,California V9 9 REVISED n-S9 YM a-at ATLAS - t .� 1� 1