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FOR OFFICE USE: - v ------ APPLICATION FOR S NITATION PERMIT Permit No. __ � _aI__ � -------- ---�- ---------------------------------- (Complete in Duplicate) Date Issu'ued ----------------- -- _------ This Permit Expires 1 Year, From Date Issued Application is hereby made to the San Joaquin Local Health District for a ermit to construct and install the work In ein described. This application is made in compliance with County Ordinance No. JOB ADDRESS AND lON - T .: `ter--•/-�---- - -- --- --- ---- --�------------ - 1.. u _ --- -------- Phone. `---- Owner's Name------- --- ------------- --- o �,.r 4 -- Address------ tom" -- ------- ----- a Contractor's Name_ r� " Phone"?'� ._ _ �. = ---"- ..... 3 Installation will serve: Residence pertment use ❑ Commercial1Z Trailer Court ❑ Motel ❑ Other ❑ Number of living units-. __1-__ Number of bedrooms _Z__ Number of baths _1---- Lot size ------ ---x.---6,-a--- ------------------ Water Supply: Public system l]i�ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy4Loam ❑, Clay Loam El Clay 13 Adobe Hardpan p l � r Previous Application Made: (If yes,date-------------------- No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if pu .' vier is available within 200 feet,)/ ' Septic Tank: Distance from nearest well Distance from f undation- I Mater-al--_ ___ �° 1 No. of compartments------ -------- ¢e � •-`d- -- --Liquid depth --- .1--..----Ca acit a I � Disposal Field: Distance from near st well_ __ Distance from foundation----1-jO---_-----Distance to nearest lot I„----------------- Number ____----"----_- Number of lines--- _ ..._____ _-------Length of each line___,/--97-f- __ Width of trench-�4+-L_._------------------- �s pQ i Type of filter materia' - - ept h of filter material---_�._ _____.._--Total length--------------9----------_------------ Seepage Pit: Distance.to nearest well-------_ ___....__ Distan rom oundation---.-- -�--Distance to nearest lot line----------------- LP Depth_-a�-- - r Number of pits.---I-------------- ining material__--- t_-__. size: Diameter._ ___ ---. -----"-.------ >' Size: Diameter_ Barest well-----------------Distance fro oundation--.--------_._-_---.Lining materia4-------------------._-.-.--"-_-__--- S Cesspool: Distance from nt -------------------- -----------Depth-----------------------------------------------.---Liquid YC'apacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------._-_--.._--_-_------------.-_..._. ❑ Distance to nearest lot line--------------------------------------------- - ---------------------------------------------------------------------------------M1-7L-------- - R ---- Remodeling and/or repairing (describe) ------------------------ yp a y - k I.here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St l and ralat and regulations of the San Joaquin Lac Health District. .---_-__-- r Contractor) (Signed) ------- ----------- --------- `F �. - -- ----- ------------------------ --- T �'�" ud{� I � By:---------------------------------------- '--- ---------------------------- ----- -- -- --- --- - ------ (Title)--------------------------- ---- - ---------------- (Plot plan, showing size of lot, location of system in relation to wells uildings, etc. can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----r -`---------- - - --------- ---;------------------------------------ DATE--- �7"_._.-------------------- r REVIEWEDBY.---------- 1--- ---------------- ------------------------------------= - --•----------------------------------------- DATE------------------ --------- ---------- ---------------- ' BUILDINGPERMIT ISSUED------------"--•--------------------------------------- -- •--------------------------------------- DATE-------------------- ---------------- - ------ -------------- Alterationsand/or recomr�endati ns:--------- --- --- ----------- ------- --------------------•--------------------•-•---------------------•--------------------------------------- !` ! _ . .......... - ---- ------ ------- --- - :�._ <- ------------ ------------------ ----------------- . ----- .. ts_ '� �LCa mu�nr�.w: . :-�c�Cd� ''LG'7-t.[.:. ��•'i�-v I FINAL INSP • : ---- -- " , SAN JOAQUIN LOCALEALTH DISTRICT 1601 E.kaielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California f Tracy, California I /./ 1-.