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FOR OFFICE USE: . --------- f � Perm- it �APRLIC4TIONAF&-SANITATION PERMIT No. .. �omplete-in.Duplicate)------- ------------------ ------- --- ------- Date Issued -.�----------------- - - -77� is'P-`ermit pires 1 Year-,From Date Issued Application Aereby�madee % -th6—S i Joaq�in"L 'IvHe`altll-DistFict fob a'perrriit"to coTfftrLTC-wnd'instal4-Th G7ork'herein described. This applicato n is in compliance with County Ordinance' No. 549.._' I JOB ADDRESPAI OC TION MVL `'7 ',;r4 =/q' 1..-" '-1- _1-1�+. Y -- � Owner's Nam _- —Phone--�---J ----------Address..-------" .. ........ -- --- Contractor's ame _ 5A4--------`- -------- ----- ?rPho }} -. �� - Installation will serve": Residencl Apartment Homy} L2*tZ ti erclal ❑ Trailer Court ❑ Motel y❑ �Otkel ❑ ------ ------------- ; Number of living units: - bedrooms __ ._ Number off bathsf' __ Lot size -•$_.___.._ --- - �_- __ Number of e y EA y 'y r •Sand Loam p -to-Water Table ft. Water Supply: Pu s stem Communit s stem �^Pnvate De th Character of soil fo`p depth of 3 feet Sand a Gravel e ❑ y X Clay L amX Clay ❑ Adobe ❑ Hardpan ❑ Previous Application¢Made: (If yes�!date.... ...... ....._-} No � New ConstruCtio Yesy No ® FHA/VA: Yes ❑ No TYPE OF INSTALL�iATION AND SPECIFICATIONS: Septic Tank: Distantlmparfr4nts_l rom ne rest well - Distance-from*-foundatio-n __}�""��1 t`e -- (No sep+ic tank or ce spool permitted if public sewer Is available within 200 feet.) rias- ' No. of ___----.____Size__��X__ -------------Liquid depth---S--Zt- Capacit�,r> � f r r .J Disposal ,Field Distance from near st welL-�t p--.-Distance from foundation,--1-p__ Distance to nearest lot line_---._---- �j ----- Number of lines--pK-:---- ." ..---.- Length of each line- ,_ - �__--.:.Width of trench...Z41�1 I_-____-_- -.. ,. ------- -------- Type of filter material- ._-._Depth of filter material _ r---_.Total length_--_----- --: --- ---- Seepage _.=- - Q f ! . Seepage Pit: Distance to nearest ell-J019__-----Distance"_ _ ndation--m-----_--,Distanc .to nearest lot line- --__-..- Number of -------Lining material-- ----Size: Diameter-----73-��._.--Deptn--- :. ----__•.---------- -- C_ esssppool: Distance from near e t well-----------------Distance from foundation---------- ------..Lining material..............I_-_----.------_--- ❑ Size: Diameter--- ----Y----------- ------------ ----Depth-------------t----------------- ---------------------liquid Capacity----------t---------------gals. rr-: 11 Privy: Distance from near�er`sy`t well---------------_---._---------_----.-.-- _:"'-Dist nte from nearest-building----------.--.-----____-__-----..----- Distance to nearest Ibt line ------------- :i-------------- ❑ ' - - --------- , Remodeling and/or repairing (describe):---- - _ ------------- - ---- ------ --- - ------------ ----- -- ------ ------ ---------- --------------------------- --------------------- ---- ---------------------- --------------------------------------------------- ---- ------------------------ ------------------------------------------------------------ --------------------------------------------------------- I hereby certify that I hav prepay this application and that the will be done in accordance with San Joaquin County ! ordinances, State laws, and r sand re Mations of he San Joaquin L Health District. (Signed) ------ ------ ---- -- ------�11/lir r- -- - -------- --- /C ------ - ----.(Owner and/or Con+ractor) 9 f �- --------------- ------------(Title)----- �. -.,. (Plot plan, showing size of I•4, ocation of system in elation to wells, buildings, etc., can be plat on reverse side}. + - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. .- -- o --------------------- DATE - .�- - ----------- ------------------------------- REVIEWEDBY----------------------------- ------- -------------------------------------------------------------- =------- ------- DATE--------------------------------------------------------- - BUILDINGPERMIT ISSUED-----------"------------------------------------------------------------------------- ----- DATE------------------------------------------------------------- Alterations and/or recommendat-ons: - i' --•------ftp - -------------- - ..... s�•------ -��r �r: ------------t,4-------------------------------------------- ---- ----- -------- ------------•-- ------------------------------- `--------------------------------------------------- ------------------------------ I Is ------ FINAL INSPECTION BY:.------...`:--- ----- Date----._....../_--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave.,,,.. - 300.West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California, Lodi,California Manteca,California Tracy,California - - r.P.C Q. f I