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F R OFFICE USE: ------------------ _4, --------------------------- .�,, APPLICATION FOR SANMATION PERMIT Permit No. �............... ; (Complete in Duplicate) Date IssuedJ�__�=�:. - ...--------------------------...._ __ .__._..____._._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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__J_`�__7 R__je___.!Na vl"L____________________________ l Owner's Name_,__,_&,_,2�_ ------...e -------------------------------------------------- _ Phone-----------•-------- Address-----•----- f-----Q----�---�-;---------------- (/- Contractor's Name---------- -Z-A-4-------- � �..��x�Yet l��l -------------- Phone.._-.------------------------------ Installation will serve: Residence ❑- Apar menntt House ❑ Commercial Ej Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __t____ Number of bedrooms __3__ Number of baths-7- Lot size ------------------------------------ Water _________________ ___Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O�Hardpan ❑ t Previous Application Made: (If yes,date---------------------) No I]'_ New Construction: Yes Ej- No ❑ FHA/VA: Yes O--No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). _4 Septic Tank: Distance`from nearest well--- ----------Distance from foundation/P------------.Material__ °zi:r' .______ No. of com artments____�___________________Size_.__....____S�___!____,___Li Liquid de th__._1_..-____- P �k q P. --------.Capacity... Disposal Field: -Distance4from nearest well.._.'._._.___.._Distance from foundation___ ----Distance to nearest lot line____ ____ __________Length of each line___`� _ -------------------- of firench_ - -----,--•------------___-_- Type of filter material--___ J ?_S- ____-Depth of filter materiall ------------------ length---cle-F- �_______-.=...............� Seepage Pit- Distance fo:nearesf well-----4 --_------_--Distance from foundation__Zd-,_______.Distance to nearest lot,line----------------- Number ___ -._--.._Number of pits_____ --------Lining material-__Xnf__lt-----Size: Diameter____ , ------------Depth____ .9.7..___________.__ Cesspool: j Distance from nearest well-----------------Distance from foundation--------------------Lining material-.___-.-____.- ---------.---.._. ❑ Size: Diameter-------------------------------------Depth---------------------------------- -----------------Liquid Capacity-----------------------------gals. Privy: Distance'from nearest well---------------------------------_-------------Distance from nearest building___._...______________________---..__. ❑ Distance,to nearest lot line-------- -------- - -- -----------------------------------------------------------------------------------------------------------=------ r Remodeling and/or repairing (descrihej::-f*_ ! .r �.p�.= -�,.'1 �' ` �' t .` 1° -------•-------------------------------- riyfit'__a4f .a. --_4_5f/, s� ✓c1 r-IL---!a"- + retTft_ '�f C1 ! s em=+ iv ------------ r k I ---------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- - - 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. (Signed)--------------- -------- - ------------------------------------------ --- ------ - -------- --- --- --------------- -------------------------------------(Owner and/or Contractor) Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----- ------------------------- ---------------------------------------- DATE f� .._ �.------I------------ REVIEWEDBY--=--------------------------- ---------------- --- ------- --------- ------------------------------------------------------- DATE---------------- ------------------------------------------- BUILDINGPERMIT ISSUED------------------ --------------------------------------------------------------------------:------- DATE------------------------------------------------------------- AI#era ionsa d/or recommendatio -_._ a , -- ---------- -s �<---,-1_A--L-_�------------I°---- ---------- ------------------- --------- ---------- ---- -------- -------------- ----- FINAL INSPECTION BY:..........ee�e?---------------------- --------------------- Date---- /z_/ z � ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 3