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FOR OFFICE USE: C� �` 3j6 1 Permit No. - ----------------------------------- -----AAAA-- AAAA- - - At PLICATION OR SANITATION PER�,rr ----------------------------------------------- - (Complete in Duplicate) Date Issued ' This Permit Ex ires�1..Year From Date Issued ------------------------- ------------------- Application is hereby made to the San Joaquin Local Henath DiNoc for a permi to co`struct and install the work h es ed. This application is made in compliance with y •! L��,� C, L JOB ADDRESS AND LOCATION_--- --- = - -- �� - --cam. ----�AAAA-- - ---•- --- `��-. � n /moi••-e—_�_ ------- ---------------- ------------- Owner's Phone_. t�-'x• AAAA------ •- I Owner's Name_ ----------------- -------------------------------------------------- C/) - -- - T per' - - ,�7 ,7. ;____A Address Phone.... 1114 Contractor's Nam _________.-- �.y -- . -� f f I Installation will serve: Residence/ Apartment House ❑ CEnber merciak ❑ Trail/e�r Court "Motel ❑ Other ❑ Number of living units: (--Number of bedrooms l� of baths/6- Lot sizeft Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ----- Adobe Hardpan ❑ P ire e [��andy Loam ❑ Clay Loam ❑ C Y ❑ Character of soil to a depth of 3 feet: Sand ❑ rl No ❑ New Construction: Yes o ❑ FHA/VA: Yes'❑ No ❑ Previous Application Made: {If yes,dot,#_/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) iic Tank: Distance from nearest weld - -- Dist�nfce frost foJ�n �f ion__. Material____-_ ��"`"` `----------------- _a7_�iD� q p. Ca acity �r_A�'� /�r I No. of compartments_- _ Liqui de th__ r-f----- P r, ��-' �ffJ _Distance from foundati n__�-Q- ,pistance to nearest lot line.---._f�:- Disposal Field: Distance from neare1st well_-- Length of each line_-�92t�-f --J d-.Width of trench---A_y� '------ ----- t ®� Number of lines_f�Q- - g -----AAAA-- W Depth of filter material___.__� �!-----Tota! leng.th_____-:. _ Type of filter materia i P Q "' 7Distance�rom foundation--_____ _-� Distance to nearest lot I'sne_-_ -AAAA-- V/ l �'� ,� _ AAAA z?----- , f De th----- —-------- ------ Number e Pi}; � Distance to near /It well- - - Linin material__-____ .. _ _ ___"Size: Diameter___-�-�AAAA-- P Number of pi't's. -------- g Cesspool: 'Distance frci earest well___---_____----_Distance from oundation------------------- Lining ma#erial_______________________------------- s 1 -Depth-------------------------------------- -------------Liquid Capacity- -------------------------gals. Size: Diameter------------- --❑ r Distance from nearest Weil____-__---:AAAA--AAAA-- -Distance from nearest building---------------------------------- ---- f Privy: ---------------- -------- C' ❑ Distance-to nearest lot line--------------------------------- ------------ Remodeling. -- --- - ----------AAAA•------------AAAA----AAAA-- - pi ------AAAA-- --- --- --- ---------------------------------- Remodeling. and/or repairing (describe)- -- --- -----/ -�---- - -- , - ---- . - AAAA - ----•--------- ------------------------------------ -------- ------------- -------- --------------------- ; --------------------------------------------------------- ---- -AAAA-- -- - AAAA- - --AAAA-- AAAA- -AAAA--`--'------------------AAAA--'AAAA----------AAAA-----AAAA---AAAA-------------AAAA---AAAA-------------AAAA-- ------ -------------AAAA---AAAA---AAAA-, done I hereby certify that I have prepared th}sans f th'cation San Jo uinhLocal kHell tlieDistr ctn accordance with San Joaquin County ordinances, St jaws and rule ,and regulations I on r C- tactor (Signed _- 4 ------- ----- - ------- - --------- -- AAAA- -- -------------------- gY 1. (plot plan, showing size of lot, 10�ation of system in r ion to wells, buildin , etc., c be placed on reverse side). FOR DEPARTMENT USE ONLY �?_ - ----------- APPLICATION ACCEPTED BY_.- - ----------------------------------------------------------------- DATE---- AAAA �-`�--- -AAAA-- - ----------- - . DATE------------------------------------------------------------ REVIEWED BY---------------------------- - --- BUILDING PERMIT .ISSUED----------------------------------------------------------------------------------------- - DATE. 1 Alterations and/or recommendations:__;- ---.--AAAA-- --------- -------------•--------•----------- i __________________________________ ----•--------------- ______________________ ________________________ 1:1 ____________________________________ - _____________ ._.____-___-_-_---.------------------------------ ---------- ----------- ---------------------- Date. `` (' - FINAL INSPECTION = --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 's205 West 9th Street 340 West Oak Street 124 Sycamore Street _• 1601 E.}fasslton Ars. Trac California Stockton,California Lodi,California Manteca,California y� F.RG9• f - r -