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FOR OFFICE USE: -------------- --------� -"°'- --------------------------------- ------. .(5----- APPLICATION FOR-}SAWTATION PERMIT Permit No. ------------------------------ ------ ----Ife-Q----- (Complefe in Duplicate) --------------- This Permit Expires 1 Year From Date Issued pate Issued __- 2�//Cs_ Application is hereby made to theSan Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ .?. u E ` t-`s-�E-}3.E� I VE . h� - -- ---------------------------------------------- Owner's Name------ --•-----t r' x � -------------- ----------------------- Phone---------------------------- •---- Address------------------_ t Contractor's Name----- 5 -�------------ - #L-------------- ------ Phone-4-16-4-7-3-1_44f_Z- { Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..I.... Number of bedrooms !,?__ Number of baths ----L Lot size -----to-a- Water Supply: Public system r Community system ❑ Private ❑ Depth to Water Table 164- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E]Previous Application Made: (If yes,ldate"_:___..___ _____) No New Construction: Yes ❑ N ok FHA/VA: Yes ❑ No Jk" TYPE OF INSTALLATION AND SPECIFICATIONS: Not (No septic tank or cesspool permitted if;public sewer is available within:200 feet.) Septic Tank- I NFi Distance from nearest well__._.....-.____Distance from foundation-------------------.Material_-------- __..-....- � ❑ C' No. of compartments---- ---------------------Size---- •----------------------•---Liquid depth--------------- - --------- ------ Capacity------------------__-.- _. Disposal Field: Distance from nearest well................_Distance from _ foundation-------------------- to nearest lot'line----------------- ❑ �,fil+�7l��i Number of lines#-------------------- ---------Length of each line------------------------------Width of trench--------------------- �1 Type of filter material..._-___--------------'Depthtof filter material..._.___-__.._-..._-_Tota! length..'.--....._._-.:_......- W Seepage Pit: Distance to nearest well---TONE___=Distance from founclation------C.I-_`..-..Distance to nearest lot line--------------- Aot> Number of its--I...' ---._-_---Linin rriate�ial_sC_._ R K"Size: Diameter__-_. ___.r_�t p ' ?��---------- I p t I:� g t --- �---Y•- ..De tn----------- � Cesspool: Distance from nearest well----------------'Distance from foundation------------------- Ening material__.-...-..-._....-----__..-..-_.._.1 ❑ Size: Diameter ---------------- ----- ---------Depth--------- --------------------------- --------------Liquid Capacity---------.......................=----gals.' I Privy: Distance from nearest well______________________________ ___ --------- Distance to nearest lot Gne........ _ . Remodeling and/or repairing {describe.:....- _ S---Y 4 T- rF -------4 ---------------------------------- •----------- E •-----------------° - ----------------------------- -------------- ----- ---------------------------------- ro ------- ---------------•------- --------------------------------- -------------------------)--------------------------- 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. r— (Signed) — `_ I a � I (Signed) ' ------ ---= - _ 1[Owner and/or T I a ------- --- ------ - By:.- ------------------------------------------------------(Title)--- ------------ ' -------------------- Contractor) - r�r . (Plot plan, showing size of lot, location o syy�,fenm in relation to wells buildin s etc. can, buildings, be_placed on reverse side). ( ! FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY.-.--- _. :-� _/ ' r -t-- ----------------------------- - DATE---... /1; :�-f __e` ----------------------------- REVIEWED $Y -------------------------- ' DATE BUILDING PERMIT ISSUED ------ --------------------`---------------------------------------------------------- DATE------------ Alterations and/or recommendations- ----- ---------- --f------------- ' ; --- ----- --- • - _i ---- - I ---------------------------------- --------------------------------- t. I .. FINAL INSPECTION BY: --- ------------- ------------ Date =• r. i�..:.- , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 C.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.0 O-