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FOR OFFICE USE: --------- --------------------------------- ---- ----- ---------------------------------- APPLICATION FOI SAWATION PERMIT Permit No. -1.�-��... -------------- --- --- ------------------------------ -- (Complete in Duplicate) S� 6 -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the war ere-:n de tribe This a plication is made in compliance with County Ordinance No. 549. p��r_ �^C�6 .!�') �3 ,E . ►�-t�a�.. ccs . >!"�,� ,�' ,� ADDRESS AND LOCATION_:4/, �'----- �i 'fj� ' ,�--f= lr ---------------- JOB --------- Phone------------------------------------ A ---------------------- -- Owner's Name-------- �9,� �1�'' •---- - - Addres.----------- �----S4?ll /y—�.-1...- + {4`�� ----J--------------------------------------•----•-- Contractor's Name----141001 /-? Wdo1� --------------------------- - --• •----- Phone--------•--•-------- Installation will serve: Residence WRIlpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms _f_ Number of baths •- Lot size f :'-------------------------------- Water Supply: Public system [-] Community system rivate El Depth to Water Table APItt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe��'ardpan ❑ Previous Application Made: (If yes,date-------- ----------) No WRI ' New Construction: Yes-j5e-hlo ❑ 'FHA/VA:—Yes &' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,-0 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-_!!r!T" ._-Distance from foundation-_,/&---_....Mat ri Ir -- _._.____.No. of compartments-.--��4- ----------- - -- depth._ ._....__...___Capacity --- Disposal Field: Distance from nearest well---. +-------Distance from foundati n--. t --------Distance to nearest lot line_ __�'___________ Number of lines------x....x.__. ______ Length o -_ ..f each line- a-� Width of trent __ ------._-_____________.__ Type of fil#er materia Depth of filter material ---------------Total length f ----------------- i � Seepage Pit: Distance to nearest well-.--- ----------Distance from fo dation--,� -_------Distare-to-nearest lot line __.--.-- Number of pits---. _....____Lining mate ria l .Size: Diameter.":�__...___Deptha .__ c_. Cesspool: Distance from nearest well-----------------Distance from foundation____---------------Lining material_--._-------.-._______-_-_---_--. ❑ Size: Diameter--------------------- - -------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest'building___i_____.__________-___-____.____---.-. ❑ Distance to nearest lot line.---------------------------- ---------- - ----------------------- �� 'g � ` Remiodeling and/or repairing (describe) - GltC� =------f----- - - --------- ----------------- ------ `r------------------------------- ------------------------------------------------------------------------------------------- ---------------------------- - ------------ i I =------------------------ -- ------------------------------------------------------------------------------------------------- ! hereby certify that I have prepared this application and that the work will be done:in accordance wit)1 San Joaquin County ordinances. State laws, and ides and regulations o the San Joaquin Local Health District. it (Signed) I {�,�. Contractor) Oy:----------------------------•------------- ---------------------------- -----------------{Title} - � ------------ (Plot,plan, showing size of lot, location of system lation fo wells, buildings, efc.,,can-bei .laced on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- DATES REVIEWEDBY----- •--------------------------------------------------------------------------------------------------------------------- DATE------------- --------------------------------------------- BUILDINGPERMIT ISSUED------------------------ ------ -- ,��J --------------- ATE------------------------------------------------------------ Alterations and/or recommendations:-----.-. G� (� _••-� �----- ----------------------------------------------------------- --------------------------- ---------------------- -----------------------------------------------------•----------------------------------------------------- ------------------------------------------------------•---------------------------------------- ---------------------------------- -- -------------------------------------------------------------------------------------- FINAL INSPECTION BY: ��/a�� --•--------------- Date. ` ... ------------------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Mt. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.