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rvrcvrrltt: USE; "--"-- ------ ------------ --- :---- :------ - APPLICATION FOR .SAiATATION PERMIT Permit No. --"` [Complete In Duplicate) ` This Permit Ex ires i Year From Dale Issued Application is hereby made to the Date Issued Y San Joaquin f_aca! Health District for a permit to construct end,inshall the work herein described. This application is made in compliance with County O dinance No. JOB ADDRESS AND LOCATION' Owner's Name----- J _ - - -------- -- ------- --- i- - --�="� - , "- -- ---- - Address ` Phone""�i Contractor's'Name-__� • .__".."_" . `� -0. � ----------------------------- Phone-6 .1��e-7". Installation will serve: Resi�ence Apartment House p Commercial I � ... ❑ Trailer Court ❑ Motel s .. . t : ❑ Other ❑ f Number of living units: -1---x_.Number of bedrooms "" � � # Number of baths.-_ _-_" Lot size " lee x Water Supply: Public system ❑ ommunit system a ---•------ I Y Y ❑ Private ER Depth to Water Table�Q- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ .Sandy Loam M ClayLoam Cla ! Previous Application Made: (If yes,date__ ❑ Y ❑ P`dobe Hardpan ❑ I -- 1 No ❑r New Construction: Yes X No ❑ FHA/VA: Yes ❑ No t TYPE OF INSTALLATION .SPECIFICATIONS:.. 1 ', (No septic tank or cesspool permitted if public sewer is available within2280 feet.) a� i Septic Tank: Distance from nearest weif__(OQ�"--_-Distance from ou da'tion" ` i 11 No. of com artm1ents" t. AQ------ Material -_- ----- --- ---- ---- _- p ----Size_"_4:X- Liquid th_ sf Disposal Field: Distance from nearest wefL._�,��-._- Distance from foundation-_ A P � � --- Capacity/,�i�7p y° Number of lines.__ -" Distance to nearest lot line"f -- -.__--Length of each line_.__ ._ __° _ r Type of filter material""- . �� .- - 77------width of trench.-__�lf Depth of filter materiall _------Total length-."- 'Q �fC- Seepage Pit: Distance to nearest well_. $7 Or - . Distance om f undation_"_ Q._-._-". Number of its - Distance to nearest lot line_1iQ_r".- P � Cl -Lining material--- __ . _-- Size: Diameter.-.3 !� t ----Depth--�,5------------ Cesspool; Distance from nearest well__"_____________Distance from foundation...........--""_ ..Lining material"-_..___-._.__--.-.-""- - ❑ Size: Diameter- -- -4,`--- _!..Depth-- --_ .-. r _,y . ..- ---- -------Liquid Capacity Privy: Distance'from nearest well____` ��-, `- k -- -----gals. { ...... "_..Distance from nearest buildin ❑ Distance to nearest lot line 9-- ---------------------------------"--.. i. ------ J Remodeliand/or repairing (descriheJ:" - ---------- - -------- ng _ ------- ?� ------- -- --- - --- ------- ---- ------- ----------- 9 ------ -- 4 -- ------------ --- -- Iy _ -`------------•------------------------------------ ----Ul�+i, - - --------------"---------------------------------- ------------"`-'------------------------------------------------------ ! hereby certify that ave preplication and th the work will be done in accordance with San Joaquin County ordinances, State laws,"It an rules andof the San Jo uin Local Health District• (Signed)----- ---------------------------- By f By--- -------------•--- _ ----T.----------- -- -(Owner and/or Contractor) .- (Plot plan, showing size of (ot, I ation of system in relation to we s, buildings, etc., catl(bele)�ace on reverse averse side). FOR DEPARTMENT USE ONLY REVIEWED BN "ACCEPTED BY" /Y1l1 yCd---- ---------------------------- L. APPLICATIO Y. DATE -- REVIEWED PERMIT ISSUED---------- ------------ - -------------- - ----- -------------- -------------- ----- DATE- ---- ---------------------------- Alterations ----- -------•------ ------------- ------------------------- ------------------------- ------------- DATE.- -......................, , Alterations and/or recommendations:.- -------------------------------------------- --."__-_-.-"_...-___--___--""---."- -------- } ---------------- --- ---------------•------- --- --------------- ------------------------- ------•----- ------------------------ � � ------ ...... ....... FINAL INSPECTION BY:..____._.. --' Date----- --- ------ --- �--Y-~-G`7 ____ _ __ - • ----- -- - rSAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi. California 305 West 91h Street E.H.92M 1.67 Vanguard PressManteca,California Tracy,California , 1