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------------------ ---------- -- %PPLICATION FOR` SAWATION AMIT Permit No. lr ----------------------- (' -------- ----------- (Complete in Duplicate) ------------- -- -------- .3- (�'7 . Date Issued ----- -------- ----------- ------------------ This Permit Exeires..1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit _t and ih5ql the work herein described. This application is made in co.mpliance with County Ordinance N6. 549. ;�� tAl'l EO -----Irtz.44 14--4 JOB ADDRESS A��D-DOCATION , 1 ------------ --------------------------------------- Phone___"4=_e___d6__._ Owner's Name------ ... . ...... Address.------"� _ -------R* 3-------� --•-_ _ _--�_ ---------------------------------- f -1 Contractor's Name--- -------/*--- --------------------------------------------------------------------------------- ------------- Phone----------------------------------- op Installation will serve: Residence.[] Apartment House E] Commercial E] Trailer Court El Motel 1] Othert Number of living units: umber of bedrooms -------- Number of baths -------- Lot size --- ___-___.------_---_----_._-.__ Water Supply: Public system El Community system.El Private Rj--Oepth to Water Table -------- ft. Character of soil to a depth of 3 feet. -Sand E] Gravel E] Sandy Loam F Clay Loam EClay ❑ Adobe I Previous Application Made: 11f yes,date-.--------- I No rl New Construction: Yes Ej No 0 FHA/VA: Yes 0 No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ------ ---------- SeRtic Tank: Distance from nearest 110-0"I'm ta�ne fro -------_Maters t�er i is' uid clep�h___ apacityc- - ------------ size No. of comparfmen f. I C Dispoyl Field- Distance from nearest well-/00-Y—Distance from founclation�7_0----------Oistance to nearest lot line---.;5-v--- Number of lines--- Le gfh of each linejjoo_�---------------Width of trench-_-./0_.�-------------- f filter material--- -/' 00-Total length-./40- -—------- Type of filter maters epth 0 Seepage Pit: Distance to nearest well- ------------------Distan'ce from foundation-on--------------------Distance to nearest lot line_--------------- El Number of pits........ -------------Lining material------- ---------------Size: Diameter------------:- - ---Depth------------------------ - ------ Cesspool: Distance from nearest well-----------------Distance from foundation.--.-.-----_..__--- Lining material_----.--___-____---._-_-..--____-..-_ ❑ Size: aterial--------------------------------- Size, Diameter------- ---------------------------- Depth---------------------------------------------------Liquid Capacity------------------ - -------gals. Privy: 1 Dis41'e from nearest well------------------ -------------------- ---- - --Distance from nearest buildinq- - - ------------------------------------- ❑ Disfance to nearest ]of line-- -------------------- -- --------------- ---------------------------------------------------------------- -------------------- Rem and/or repairing [describe) ... .... - ------ ----- __V------------ k: ---- ------ --------- -------------- Ig - ------ ---:) _'_ - --- - ----- --- ----i(---'a -------- - ---- -- --- - - -- - ---------- - -------------- ---------------------------------------------------------- - ---- I hereby certify that I have prepared this application and that work will be done i accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San l��auin Local He District. (Signed) ....... . .... .... ------------------------- - -ml0tvin Contractor) ---- --- ------ _02 By:-------_---------------------- ------------------------------I-------------------------- - - ---- ------LATitle)---------- ----- - --------------------- -- ---- - -- ----- (Plot Oan, showing size of lot, location of system in relation to ells, 6uiilding.s, 7a.,Jcan be placed on reverse side). FOR'DEPARTMENT USE ONLY DATE------------------- APPLICATIQ�NAC�CEPTED��BY, __� -- -------- --------- ----------------------------------------- ff=,�?-7------------------ - =W F-ri Y -------- DATE--------------------:-------------------------------------- - --------------------------------------- REVIEWED BY----------------------------------- -------- ------------ - ------------ BUILDING PERMIT ISSUED-4�--- --------------- DATE.---------------------I-------------------------------------- ------------------------- ----------------------- AAlterations a�'flons!--------- -----------I------------------------------------------------ Ite ons and/or recomrii6h ---------------------------- ------------------f------------------------------ I, — - IFr ------------------------------ ------------------------------------- -------- -------------------1_----------------A--------------------------------------------------------- -------------------------------------------- ------------------- ------- ------------------------ ------------------------------------------------------------------------------------- ------------ ---------- ----------------------------------- ----------- j --------------------------------------------------- ---- -------------------------------- ------------------------------------------------------- ---------- ------------------------------------------- ---------------- ----------I------ ---------------- - ----------------------- ------------------------------------------ ---------------------------- ---- ----------------------- ------------- --------- - FINAL INSPECTION BY.- Date.- ------------------------------------------- ---------------- ------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.