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FOR OFFICE USE: 7 . •. "-----" --------- -" ----" -------------------- � APPLICATION FOS SkI�ITATION PERMIT Permit No. ../ ------------------ --------- -------- ------------- (Complete in Duplicate) Date Issued .. s--- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein describer This application is made in compliance with County Ordinance No. 549. ,/Js- -. = .LOB ADDRESS A LOC TION. --�f---��-�� ./� .......... � � � Owner's Name t --��5----C~---_U------------------------------- -------------- -----------lie-fl�l-.- ' ----------- R---- or I - __l-_5�--�--"-----lv�"r-----"--S`l� � ---------------•--•----•-------""---------""---- Contractor's Name---- -------------- Installation ------------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other ❑ Number of living units: -J_-- Number of bedrooms _�1'Number of baths _-.r<"-- Lot size -_- .. --.. -- Water Supply: Public'system ❑ Community system ❑ Private K Depth to Water Table 6.0 ft. L Character of soil to a depth of 3 feet: Sand [–] Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe (9 Hardpan C] Previous Application Made: {1f yes,date------ } No New Construction: Yes ❑. -No V—FHA/VA: Yes E] Nom_ ` 'TYPEOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'Permitted if public sewer is available within 200 feet.) i` Septic Qtic Tank: t nce r nearest well--_-------_-----Distance from foundation__.----_--------.-.Material---.--_--------------------------------- Liquid depthCapacity &,.5� Nocompartments ------------ _-"-... Disposa► Field: Distance from nearest well_.15_V-...Distance from foundation-_- -----Distance to nearest lot line--�..-----_-- Number of lines----- Q - ----------Length of each line--- - � ------i�-----.Width of trench__--t{"----------------- �, Type of filter rnateriad__"'�.,_.& Depth of filter material------L-f--------.-Total length-------- =-------------'--ir - I ' r r Seepage Pit: Distance to nearest well .......Distance from foundation-_-_�-Q-..--_--.D- tar��e to nearest lot liner-�--------- / Number of pits--QY e G=�--Lining material-t 1l-"_p�.iV-,(Size: Diameter----- ..._ .Depth----- - ------------------C Cesspool: Distance from) nearest well__--.--_--.-----Distance from foundation---.----------------Lining material--"_------------------------ al-- p ❑ Size: Diameter---- ---------------------- -----------Depth----- -----------------------=---------------- ----Liquid Capacity --------------------------9 ----Distance from nearest building...Privy: Distance from nearest well--------------------------------------------- g-..--------- """""----""""" ---�------� ❑ Distance to nearest lot line ----- ------------- -------------- ----------------- - ------- Remodeling and/or repairing' (describe):----- -- t ----------------- -------------------------------- ----- .•---------- . I -' * -------------------------------- -----•-------------•-•----------------•--------------- ------ --------------------------------------------------- d ------------------------------------------------------------ it ----------- ! hereby certify that I have{prepared t ' application and that the work w' be done in accordance with San Joaquin County ordinances, State laws and rul :'and reg at' ns of the S Joaquin Local th District. i_ caner and/or Contractor ----- - -- rw' F #. ------------- ."�"." B ------------(Title) Y--------------------- (plot plan, showing size of lot, location of system in vela ion to wells, buildings, etc., can be placed o reverse side). r FOR DEPARTMENT USE ONLY - -------- - --------------------------- ------ DATE APPLICATION ACCEPTED BY-.__."_.--"."-___._ .- -:- - ---------------- -- REVIEWEDBY--------------------------------------------------- --------------------- ------------ ------------------ -------- DATE------ ------------------------------------------------ BUILDING PERMIT ISSUED---------- . ------- ------ DATE-------------------------------------------------------------- Alterations and/or recommendations----------- ---------- -------------- - ---- 1 ------------------------------------------------- ----------------=------------------------ -------------------------------------------------- i --------------- - ---"--------------------- ------------------ -------- -- ----------------------- ----------------------------------------------------------------- -------------------------- ----------------------- ------------•------------ ----------------- ---------� -------------- --------- "#- - ' NAL INSPECTION BY:."- .,1 9] FI Date-.7_�/-- -fO -------------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California