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FOR OFFICE USES APPLICATION FOR S,AI�.IIT ATION PERMIT Permit No. - -- -- ----------------------------- --- (Complete•in Duplicate] Date Issued ----------- ----- This Permit Expires 1 Year From Date Issued - -------- ---- -- Application is heieb made to the San Joaquin Local Health District 5f9r a permit to construct and install the work hewn described. r This application is made in compliance with County Or "_ AND LOCATION..__ . . � ._. d /2�d --- {-y5 /�`�_ JOB ADDRESS � �/ ----------- - Px0re-(�_• //11 �/ Owner's Name--.--->;9-/e.41--------Wl ._c5Q- ------...... r L -- -1-1.. OP-----------I�I>-_s----------------- �� `T��f�'=_ Address_ 1 7 one �_r_ ��' /�°-.- _- - - ------- ------- ---- --- ---- Contractor's Name__-_ . Trailer Cour} ❑ Motel ❑ ❑ - F Installation will serve: Residence Apartment ouse ❑ Commercial ❑ -�-}�__ Number of baths ._� Lot size _�- C/./2c /' --' --------------------- Number ---------- - --- Number of living units: __ .__._ Number of bedrooms / Water Supply: Public system ❑ Community system ❑ Private g Depth to Water Table _ C� ft Adobe ❑ Hardpan ❑ p.. y-_". c ❑ y Clay Loam ❑ Clay Character of soil to_a_ depth of 3 feet 5andK Gravel Sand Loam ❑ YFHA/V,A:. . No-❑ - _.No � New�Construction:-�Yes_0 ,dor❑�..-- Yes � Previous Application Made: llf yes,dote, -_-7_x_))- F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] G Q--------.Maters ! ------------------ Septic Tank: Distance from nearest well__c d----Distan e from foundation_.._ -- — Ca acit / --- I No. of compartments_.._.------ Size_�X --x-C'------Liquid depth_.. P Y--- Dis osal Field: Distance from nearest well ...6`0-"-Distance from foundation___f_d .Distance to t nearest lo�)ine____�----•- P Len th of each line__ -----f--¢--�----- -Width of trench--- Cid�"----------------- ,Z Number of lines.--------- --------------- 9 Type of filter material--._ <' -----Depth of filter material----f ---------- dotal length-_-Z ------ neare Seepage Pit: Distance to nearest well-_--___.Lin-- -----Distance from foundation---iometer-----------------------Distance to Depthst lot line ---------------- ❑ Number of pits--- -----_____ 9 __ ing material--- Cesspool: Distance from nearest well ----------------Distance from foundation.._._------ Liquid Capacity gals, ❑ Size: Diameter- -- --------- ----- --- ------ ---Depth-------------- -------------- - ------------------ g n Y ---------- ------ _ ---__._.__Distance from nearest building________________"----------------------- Privy: Distance from nearest well--------------------------------------- ❑ ------------------ ------ -------------------------------------- Distance to nearest lot line--------------------------- --- ------ ------- ------- - Remodeling and/or repairing (describe):---------------- ------ ---------------------•----------------------------------------------------------------------------------------------- ----•--------------------- 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 the San Joaquin Local Health District. --(Owner and/or Contract or.- �- ( g ]---42.__�_ (Title] - ---- --•---- ---r - (Plot plan, showing size of lot, location of system in relation to�ells, buildings, etc.,�canbe placed on reverse si e. FOR DE RTMENT USE ONLY ,. DATE `-7`,7------------------------- APPLICATION ACCEPTED By----- -- DATE------------- ---------------------------------------------- REVIEWEDBY-------------------------------- ---------- - --------- -------------------------- - DATE_--------------------------- - ---- ----------:------------- BUILDINGPERMIT ISSUED-------- -- -- ------------- ---------- ---------------------------------------- ---------------------- Alterations and/or recommendations:....................._........._- __"-- -- ------- - ---------- -------- - - ------------------ ------------------------------------- ---------------------- ---------- -- ---- --------- ------ ------------- ------- ------- - ---------- --- -- --- ------ - f�J iDate-- --------- /u FINAL INSPECTI --- --------- - r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielfon Ave, 300 West Oak Street r 124 Sycamore Street 205 West 9th Street " s Lodi. California Manteca,California Tracy,Californid ' ' Stockton,California F E.H.9 2M 1.67 Vanguard Press i 1 -