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4rvii v L,GVJC: ----- --------- -------- APPLICATION FOR7"SAl`irfATION PERMIT Permit No. �Z 9 ----------------------- -------------------------- Complete in Duplicate) - ---------------------------------- ------- --------- ate Issued This Permit E --D _�- - •-- x Cres i Year From Date Issued '`-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and �ssa-fI the work described. This application is made m.complia.nce.,w.ith County Ordinance No. 549. � JOB_>�""Rci3r�S��'"�T (�q Tl0 -- -- --- 2 Owner's Na.m -- ------------------ -- t - -•----••- --------------•---------------- - --- ------ ��f Phone,rf�" 0 Address--------------- ------•-c o Contractor's Na ----------------• ----------------------•----- ` --- =�.7_ ------- -_ Installation will serve: Residence ❑ Apartment House - Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- [Number of bedrooms -------- Number of baths -------- Lot size __"_-"_".---_.""."" `-' �f Water Supply: Publ ------------------------•-----...... ic system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ❑ Hardpan [] Previous Application Made: (If yes, date-----_---------___.__) No ❑ New Construction: .YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ /VA: Yes ❑ No ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well"- -Q -Distance from fou a ion_1(9�-_ - ~� Material-__J' ., -_-� No. of tom ar#mems- -- Cy ' p I Size "�]�. -� - Liquid ---- --------Capacity-----+ P Disposal Field: Distance from nearest wellDistance from foundation-------------------- # Distance to nearest lot line---------------- ❑ Number of lines-- -.-- ------------------------------Length of eachline-----------------------------.Width of trench.----------------------" LType of filter material--------------- ---__ ---Depth of filter material--------------"- ---Total- length--------.-----_"":-- -- I � �'` Seepage Pit: Distance to near t well--t- r1� --Distan from f undation_ ---- Distance tante.o nearest lot line"--_ Number of pits.:_ __------- Lining material�O __-_ Size: Diameter-"�".- Deptn I -- Cesspool: Distance from nearest well -Distance from foundation._.... .--_"-"- Lining material-- _--_ �"� ❑ Size: Diameter-"-'_J- ------- - -- -------------------Depth---------- ---------------------- ------------- ----Liquid Capacity-----------------------i gals.PrivY: Distance from nearest well---------------- --------------- ------- Distance from nearest building ❑ Distance to nearest lot Remodeling and/or repairing (describe):___--_. F----------- - ------- ----- ------------------- 34" ------_-------------------------------------------- -- ----------------------------- !-- j 11 I --- -------- ----------------•------ I'hereby certify the have.prepaled,thi pplication and that the-wo�k will be done in accordance with San Joaquin County + ordinances, State CClaws, 'Nuules and regulations of-the San Joaquin LocaltHealth District, (Si(ined} SMFeI C--TANK--SERVICE-----=----------------- ------- ------ - --- -- --- `- gy.--2915 E.Miner Ave., • M0.6•3841 �- _ caner and/or Contractor) or) , -------•------------------------ ------------------- --------(Title),---:--------- (Plot plan, showing size of lot, location of system in relay n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY V i APPLICATION ACCEPTED BY-_ -, t DATE REVIEWED BY y- _- -'------------------- " --------------------- ------ -- --- - -------------------------------- --------- DATE---- ----------------------------------------•�---------- BUILDING PERMIT ISSUED---------- ---------------------------------------------•-------------- . ATEAlteratons and/or recommendations:—? 0-.f ----- - ----------------- --- 3 �--------4A [---- is ------Qtlx---------- ---------- - ---- h_a..,1., • ----------------- ------------------------- FINAL INSPECTIONr - -------�Zo- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 7 1601 E.Hazeffon Ave. 300 West Oak Street 124 Sycamore Street 105 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i