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rUKUNILL: USt: f ---------------------------- --------------------------- APPLICATION FOR SAKI I TION PERMIT Permit No./,�'Ir?-,."_-_ -------- ----------I------- ------------- (Complete in Duplicate} ------ -------- ---------- ------------- } This Permit Ex ires 1 Year From Date Issued - Date Issued Application is hereby made to the San Joaquin Local Health District for a i This application is made in compliance with County Ordinance No. S49. . permit to construct and install the work herein described. JOB ADDRESS AND LOCATION_ Q �,�yf c. +' Q --- Owner's Name---------- - '---�1-�-- ,�.f -------------------------------------------------------------- --- -- ----------- - ------------------ -- --- ------------------------------- Address_".----------- f~� a Pone --- I a - - - ------------------------ --------------- Contractor's Name__ - . '_ _d Installation will serve: Resid ce Apartment Hou e ❑ Commercial ❑ Trainer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _33.___ Number of baths /".±r_ Lot size Water Supply: Publics stem y ❑ Community system ❑ Private,[� Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ $and Loam o Loam Clay t Previous Application Made: If yes,611 y ❑ y Y ❑ Adobe❑ Hardpant PP� { y idate__._._______-"__-) No New Construction: Yes No _+ ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- Q' Distan fro foundation--. No. of compartments.__,,- f�- d depjh---Materia!___. - - -------------- --- ----- -----Size- -- - -- ---- Ca acit gg _. Z Liquid depth- p Y p --------- Number of lines_ares# well_e _�f_�__--Distance from foundation__�a_'_.__-_..Distance to nearest lot line--- rs�a Field: Distance from net I � Length Of each line_.CS`D'_" __ `�" Width of trench--- _�{.c'____.____""""--- Type or filter materr eW__Depth of filter material-____ - - `---_---Total Seepage Pit: Distance to nearest we I :.._�-___ I � -"--___Distance from oundation__"�_ _` Distance to nearest lot iine_�__.f_--" ,Q Number of ifs. . ______.__Lining maferia .ewr p � ---- __ _____-Size: Diameter-__ - Cesspool: Distance from nearest well_________________ Distance from foundation---.------------___Lining materia)--------- ___________ ____ _ --- E Size: Diameter-----•f--- ---------- ---------- --Depth---------- - --- ..Liquid Capacity----------- �------- ----- 1 Privy: Distance from nearest well-.____--___-_ _ 9 S. _ ............." _._Distance from nearest buildin Distance to nearest lac line____________________" g ---------------------------------------------------------- Remodeling and/or repairing (descrike)----------- ----------------------- f -- -------•----- ------------------------------- I-•--------------- ------------------------------------------ -------------------------------- ---------------------------------------- -----------;--------------------------------------------------------------------------------------------•---------------------------------------------------------- ! hereby certify that I have prepar ordinances, State laws, and rules and ed this application and that the work will be done in accordance with San Joaquin County regulations of the San Joaquin Local Health District. (Signed)----- ------ - - - -------- -------- ----- B .�i�' : --- - --------- weer andr Contract 4 - -- -------------(Title}--------- - _ _ (Plot plan, s owing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - -------- �--- " DATE lZ_- 5. ----- - - VIEWED BY --- ------------------ ---------- ---I-- -- ---- - ------------------- BUILDING ---- - - ------- --- ----- DATE---- --- ................................. -------------------------------------------------- UILDING PERMIT ISSUED- ----- ---- ---9�.k-� ----------------------------------- ---------------- -------------------------------------------------------------- DATE----------------- -------- Alterations and/or recommendations: ._-.._____._ ----"- ---- -------- -------- ------------------------------------- ------------ --------- - --------------------------------------------------- FINAL INSPECTION BY:.__ r / r ----------- --------- ----- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:alton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CaliFornia Lodi,California Manteca,California � Tracy,California