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FOR.PFFICE USE: --------------- --------- -------- ---------------------- �PPLICATION FOR—ShNITATION PERMIT W/Permit No. ------ ----------- ------------- ---------- .1 --- ------------------------ (Complete in Duplicate)I - Date Issued �* This Permit Expires I Year Fr oo Date Issued Application is hereby made to the San Joaquin Local Health Districtfo permit to construct and install the work herein described. application plication is made in compliance'With County Ordinance No. 549. --------------------------- 2!�Z ----40QI ------------------ JOB ADDRESS AND LOCATION----------------- --- ------------ ...... Phone ----------------------------- Owner's Name--------------A4hr-RN1_j__,r-------------- -------------------- --------------- --------- 2_c� 7 ,." )I S F---_____________________------------------ --------------------------------------------------- ----------------- Address-- ----------JF ------------1,6.----L--------------- ----------------- ------------ Phone---.--.--------------------------- Contractor's 'Name.......�QW_Nj=�Jz-------------------------------------- ---------- ------ I Apartment House [] Commercial E] Trailer Court E] Motel C] Other E] installation will serve- Residence E-�,I . i oomsZ Number of living units: -1 ---- Number of bedrooms- -Number of baths I------ Lot size Water Supply: Public system El community system El Private P Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Cn��'Gravel 0 Sandy Loam 0 -Clay Loam [3. Clay E] Adobe E] Hardpan 0 Previous Application Made. (if yes,date-----------:--------) No Mmay New Construction'-: Yes E] No E]-'-fHA/VA: Yes ❑ No E] �TYPE OF INSTALLATION AND SPECIFICATIONS- _1 evadable ithin 200.feet.) -b -�� -av is w (No4sWpMZ�tank 6-e cessp ol�perM if fied pu ewer s ------------------------------------------------- a W ------------ -,-Di tance from foundation------------ -------Material Septic Tank. Distance from ne"resf 'ell Size----------------------------I---Liquid clepth--------------------------CapacitY-•---------------------f�_kff>Tf IJC— No. of compartments------- ------------------ Disposal Field Distance from nearest well--5.- Distance:fance from foundation---- _--___--Distance to nearest lot line-15------------ Width of trench--------- ---------- ---------------- C— Number of lines------------/--------- ----------Length of each line.----/-- tc EA ff:.2 - -____-.Total length--------- -------- -------------- 4 ADD Type of filter material----.8_0_C_?"�_Depfh of filter material------- Distance to nearest well_.___.-`_______Distance 7 Distance from foundation------/_0----.-.Distance to nearest lot line-- ---------- .Seepage Pit: ------- J--7------------------ Number of pifs......./------------Lining materia�_RQ!��K------Size: Diamefer_,5��-----------Depth---. Ft- ining maferial-------------------------------------- _e from n"arest well-----------------Distance from foundalion---- --------------L Cesspool: sspool. Distance --------------Depth_------ Liquid Capacity---------------------- -----gals. ---------------------------- --------------- FT Size: Diameter-----I---------------- - Privy. Distance from nearest well------------------------------------- -------Distance from nearest building----------------------------------------_. ------------------------------- ---------------------------------------- ❑ --------- ----------------------------------- Distarce to nearest lot line------------------- Remodeling and/or repairing (clescrj&):_�_,�Z_ZyTjF�m------ CO�J E7 Et" . .... -----hvsp--------------- - ----- - -------- Dr------- -------------------------------I---------------------7--- ----- ---------------------------------------------------------------------------------------------------7__i_R�_p 1--------------- --------------IY ------------------------ ----- --------------------------------- ------------------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------- ------------ ------------------------ i-4 11 b e done in accordance with San Joaquin County at prepared this application and that the work wi I hereby erfify that I have pr P7 Health District. ordinances, ?(to laws, and r egulaitons of the San Joaquin Local Hea tS; ----------------------(Owner and/or Contractor) [Signed ----- y------------ ------- — ---------'(Tifli)--—----------------------------- -------- ---- BY:-------------------------------- ---------------- --------- ---------------- (Plot plan,showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse-side). FOR DEPARTMENT USE ONLY ------------- ---------- APPLIAACCEPTED BY------- ---------------------------------------------------------------- DAT------------ , CATION ---------------- DATE------------- ----------------------------------------- -REVIEWED BY----------------------------------- ------ -------- -- ------------ ----------- ----------------------------- DATE-------------------------- --------------------------------- BUILDING PERMIT ISSUED At and/or recommendations:----------------------- A. --------------------------------------------------------------- -------------------------- ------------------------------------------------------------------------------------ - -7----------------- ------- ------------- ------------------------------------ ----------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------- ------------ --------- ----------------------------- - -------------- ----------------------------------------- -------------- ---- ----------------- --------- ------- -------- I ---------------------------------------------- ----------------........... ------------------------------ ------- --------------- ------------I-------- PIPA 0\J E 7 w- Atw FINAL INSPECTION Date--------- -------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Sto6lon,California Lodi,California Manteca,.California Tracy,California F.P,CD..