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FOR OFFICE USE: � - �► J-.. � �� f YF/ Permit No. ---------- ------ ._ __'-_'"_-._-_.--`-___.-_v_-_.._. APPLICATION FOR SA1�11TAT10N P�RM)T J ---- 3._3 ��/�� Complete in Duplicate) Date Issued This.Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaqith uin Local Hdealtih Dist 5for permit to construct and snstail tl}�'w�rkyl'erei scrj 1 e This application is made in co [lancery JOB ADDRESS AND LOCATkO - / p - - 44tao - - �'--- ----- - -- --- ------� - phone------------------------------------ ' Owners Name ---•--------------------------------- Address-- --- -------- one--------- ------------------------- Contractor's Name-----.__ _.- ----- - ' Apartment ouse Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence F1H P _ .- Lot size __.-__ -------�-�� ' Number of living units: �+--- Number of bedrooms _--7 Number of baths �/' th to Water'Table Water Supply: Public system ❑ Com a unity system ❑ . Private {til �eP Clay Loam ❑ Clay ❑ Adobe lardpan ❑ 0 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy ❑ ltd "o ❑ FHA/VA: Yes El y No-�! New.Construction: Yes Previous Application Made: (lf yes,date, ---- - - 4 �( TYPE OF INSTALLATION AND SPEC IFICATlf7N5: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f —A i ® p Mater Distance from foundation__/�-- ------ , 'I Septic Tank: Distance from nearest well'-I;? Lti uid depth "-' � '-- Capacity./ .�-------• No. of compartments-,'-?- � X4ra - __/______ Distance to nearest got line _7__ Distance from foundation__ __ Disposal Field: Distance from nearest well - � Width- of trench- --------------------- Len th of each line-07...---- 1- Number of fines____ -- �, i� Total len tFi_ -" - -------------------------- 1;Type of filter mater a_ ' Depth of filter mater aL_ --f: `� �{/ Distance to nearest lot Ili e 11------ I Distance f m foundation-f�----- Seepage Pit: Distance to nearest well_ ,� - Depth Number of pits___-- ------Lining mafierial �i. _. _.Size:-Diameter - ------- - P 4 ning material Distance from near st well ___--_____Distance from foundatio`-------------------- Liquid Capacity ........."-----.---- gals. Cesspool: _ " ""---- ❑ Size: Diameter_--.----A---------------------------Depth"----------------------------------- t t Distance from nearest building-------------- --------- ------- ------. Privy: Distance from nearest well-----------=---------- ---------!_.-_._______.----.- ----- ,' "El Distance to neares+-lot line________________ __ -1 ------------- ---- - ---------•---------- ------------------ -- --------------------------!-,-t------�,-!t------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------I------------------------------------------------------------------- --- ---------------------------------- ----- f i Remodeling and/or repairing (describe):---------'1 ------------- -- ._._ ' +hat the work will#be done in accordance with Sa $ ------------- . - 1. ` ------- ---j-------------------------------- - - Joaquin County I hereby certify that I have prepared this'application and I ordinances, State laws, anj rules and re ulations of the San Joaquin Local Health District. y Contractor) - Si ne ] d g ) ' ------------------------------------------------------------------ BYbuildings, etc., can be places{ on reverse side). i l (Plot plan, showing size of lot, location of system in rekati awe s, � FOR DEPARTMENT USE - ATE --------------- D ---------------- ------------------------------- APPLICATION ---��----------------- Ii APPLICATION ACCEPTED B ------------------ ---------- DATE------------------------------------------------------ -- REIEE - -- --------- DATE------------------------------------------------------------ PERMIT 155UED-------- --- ----------- ----------- --------------------- 2- 1-1 - --- -�--- ----- Alterations and/or recommendations--------�; --� { c� c �^��--- -� _ • -* '� /--_---- -=--• ------------------ -------- f -�` :z� — - - l- �[. t--------- '�� w"� -------- --- -------- ------ - ----- t��^ ---------------- ---G -�J----------- ' Date.------- FINAL INSPECTION BY:--.-Z/� <------ # SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 245 West 91h Street 1601 E.Hazelton Ave. 300 West dak Street California Lodi,California Manteca,California Tracy, Stockton,California