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FOR OFFICE USE: j- " - "GG "3,�7 APPLICATION FOR- SAWA;ION PERMIT Permit No. ._--- ----------------- + -------------------------------------- ------------- , , -------------- ------ (Complete in Duplicate) Date Issued :_ ` -�� ------------- This Permit Expires 1 Year From Date Issue - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in complian�e with County rdinance No. 549. JOB ADDRESS AND OCATION.:__ _ 4r �5p-<------ ------------------ -------------------------------------------------------------------- ------------ - ------ Phone--------------------------------- Owner's Name - -- ----- -------•---- -------------- ------------- --------------------------- ------ Address---------- --6-- - --- -------- - '-- —--- `l. - Phone----------------------------------- Installation Name------------- - -•----- --------- '----- --- ------------------------------------ -------•----------------- ------------•---- Installation will serve: Residence [g--Apartment House ❑ Commercial ❑ Trailer Court'❑ Motel ❑ Other ❑ I Number of living units: --_�__ Number of bedrooms--_I_ . Number of baths,-/,-'_-- Lot size -__��_�,0- --------•------ Water Supply: Public system F-1 Community?'system ❑ Private �6epth to Water Table _ ft. I` Character of soil +o a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Cl Loam ❑ Clay ❑ Adobe ardpan ❑ I I — No FHA VA: Yes ❑ No.[�� Previous Application Made: (If yes,.date_------------------1 No New Construction: Yes ❑ Cl / o TYPE OF INSTALLATION AND SPECIFICATIONS:, ' •P r� � � � - , (No septic tank or cesspool:permitted if public sewer is available within 200 feet.) ; v�. „_,.. i a fi. i Se tic Ta k: Distance from nearest.well+S Q:-_"_-Distance from foundation-__,_ "_".-..Mate�ia4_-..-_----"._'___--- -------------------- Septic -------------------- P� No. of compartmenfis '�. ` R=, Siie-_s.�__'�_d_y--?--------Liquid depth----- -----•----------Capacity---- y ,{ Disposal Field: Distance from nearest well-- -._..._.Distance from foundation---f117-----_"-.Distance to nearest lot line lines----rf"------------------------- --Length of each line___ Q-------------- ----Width of trench__-_ -g__---"_ ------ Type of filter material_�?.or_4-/f-------Depth of filter material--/*---------------- otal,:length-----'��- ------------------ - f Seep Pit: Distance to nearest well-. -----------Distanc,�e�from foundation--T��---------Distance to nearest lot line-------- Distance _-j. _._ L Number of pits-s ------------ g r-..._.-Depth-- - 1�----- __Lining material--h:-�.4_-�' --.Size: Diameter--..-_ _- --_ Cesspool: Distance from.nearest well_---_.._--------Distance from foundation._-_-...-_--------.Lining-material-------------------- acit --"_."------ -Liquid Ca -------gals• ❑ Size: Diameter- -------------------- ------- -----.Depth--------------------- ---------- ----------------- q Capacity --"--_.-._--_Distance from nearest building Privy: Distance fromf Barest well 9 r ----- --------------------- El ------------------------ --------------- Remodeling and/or repairing (describe):Distance to nearest lot ine----------------------------- ------ ------ ------------- - 9 ! be):_---_"....__."__--._________--____-- ----------------------------------------------------- - I ------------------------------ , ------------------------- ------------- -------- -------------- --- - -------------- - ---- ----------- ------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 ules 'nd re ul ions the San Joaquin Local Health District. St ned _' ------------------------ ------(Owner and/or Contractor) ---------- -- - ---- ------------ ------------------------------ I Title ------- �- By:--------------------------------- - ------------------------------------------------------------------- (Plot ------------------- •----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__- T_._Gr� --- --- -- ----- DATE---"=--��-"-6'------------------ ------------------------- [ --------- DATE-------- --------------------------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------ - ------' ------------ - BUILDING PERMIT ISSUED---------- ---------------------- ---------------------------` -------- ---- DAZE Alterations and/or recommendations:---------- ---------- /------ ----------------------- ... f a r r ------- '-- ----// ---- -- ------------------------------------------------------------------------------ -*1A )IN FINAL INSPECTION BY------ Date.------ - Il�------------------------- ------------- - LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California _ P F.P.Co.