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FOR OFFICE USE: —j! t I = APPLICATION FOR SATATION PERMIT Permit No. - -------------------------------------------------------- (Complete' in Duplicate] - ____-__-- _-. 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 work herein described. This application is made in.compliance with County Ordinance No. 549. ( 7_41 --t`(Q — JOB ADDRESS AND LOCATION__h- _ _.. ---N ��-"---- ------------------------- Owner's Namel�t4_n--- --------5...R, t;?:-z,-ff- ------------- - -- ---------------- ---- ----------- Phone-_�_7_�__ i�-C�'-- Acidrens____ /�.� ---- Pho ne_��'�-t.-?.- Contractor's Name , -:' �!^�'X11 - �CIYJ.S -------------- f Installation will serve: !Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel's[] Other,'❑ s Number of living units: __:1---- Number of bedrooms _C_._ Number of baths -3-._ Lot size ____ ---------------- Water Supply: Public system ElCommunity system ❑ Private N Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravelrs!' Sandy.Loam El Clay Loam El Clay E] Adobe ® Hardpan r] t .. t Previous Application Made: (If yes,date................ .] No EE New Construction: Yes Xj No ElFHA/VA: Yes No [I TYPE OFASTALLATION AND SPECIFICATIONS: I ( p No sec tan 8 tik or cesspool permitted if public sewer is available within 200 feet.) } f c � Septic Tank: Distance from nearest well__ O'. Distanee from foundation__._I_d-____.--Material. _ -f._. .C!_'----- i �7 C7U _Liquid de th Capacity ------------ - pr. No. of compartments--------- ,------------Size------��------- q R p y _ 1a p i d - _ sfoundation___� �______..Distance to nearest,lot line_- ___�.___.. r Disposal Field: Distance from nearest well__.._--__. Distance from t� Number of lines________________ !Length of each line___-----__-.____. Width of trench••.. ---__.-.___________ "7 ----- ----------- .c. 4 " § 'I Type of filter material.-.-_.K�, --------Depth.of filfer material__._M...-_.._.._Total length--_ -- ----------------------- 11 t..F /�- to nearest lot line__Q--........ Seepage Pit: Distance to nearest well frr�om foundation___ ___LiningmateriaL____/7j0.�X_.Size: Diameter._._ c ® Number of pits-------- -- - �� Deptli'`_�-�--�--•-- ----- 0. Cesspool: Distance from nearest well__-_-__.___f_---Distance-from foundation______________ Lining material_.-___-.._'-.___..--_._______-___ls. I ❑ Size: Diameter---------------------- - I----Depth------------------------------------ -------------Liquid Capacity gals. Privy: Distance from nearest well._------._.i__._-_..__- "___________________Distance from nearest building------- ___.}- .____.______.___.._.._. ❑ Distance to nearest lot line--.------. ------- -------------------------g--------------------------------------------- -i --------•--------- - ---------- -- I Remodeling and/or repairing {describe:-'------------- ------- -------------------------------------------- ------------------'--- -------------------------------- t ----------- -------------------------------------- ------------------------------- -------------------------------------------------------------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 Healfl aDistrict. ---� _'�____------- Owner an /or Contractor) J` ''----- ----------- ----------- - � - ------_-.__-_[ d ff —A {Title]_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, fc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ' �- DATE_ ----------- �::_�:.�_ -_.._._.,.. DATE:-�:--=<.---------------------------------------------- REVIEWED -BY--------------------------------- -- ----- ---- ----------- --------------- r c. _ BUILDING PERMIT ISSUED--------------- ------------------------------------ --- ------ --- Alterations and/or recommendations:-- ----�Z-23:�.-- �-� �- -�- ------- -------------------- --------------- -- ----------------- - - ----- -------------------------------------------------------I---------------------------- ------------------------ --------------------- -•--------- ----------- -------------------- I t FINAL INSPECTION BY:.---- /�/1y ---------- Date----- -----� � G_... - -SAN J6AQUIN LOCAL HEALTH DISTRICT N y 1601 E.Haselton Ave. 300 West�Ouk Street 124 Sycamore Street 2o5 west 9th Street Stockton,California -` Lodi,California Manteca,California Tracy,California f.R.C R. r __