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A.. A, APPLICATION FOR SA11411TATION PERMIT (Complete in Duplicate),I, 0 Issued 0 - 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. ? vt ,:� JOB ADDRESS AND LOCATION...._.-.. --� ` Phone --.. ' .� I . -- - ---------------------------------- O S Owner's Name_____ y ` to t -- Address__---- Contractor's Name = :.:. Ph - one �LL s . Installation will serve: Residence Commercial Hous ❑ Commercial ❑ Trailer Court ❑ Motes ❑ Other ❑ � ,,I I Number of living units: _`. Number of bedrooms ---L_ umber of baths _1.--.. Lot size --------------------- Water Supply: Public system Commun'ity'system ❑ }Private ❑ Depth to Water Table -------- ft. oil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ � Character of s p T-'A ' �� FHA/VA: Yes ❑ IN [� Previous Application Made: Y,t?s ❑ No (> New Construction: Yes, No ❑- TYPE OF INSTALLATION AND SPECIFICATIONS: - b (No septic tank or cesspool permitted if public sewer Is availablwithin 244 feet.)� Septic ank: �11is'taanee from nearest well__. _Distance from;foundation.� ' _...-- MatenaL.:--:. ------- No. of compartments---------- - -- i Size- � �9 -------Li Liquid de th..._ ---------------Capacity..__-g- -=--- Z- ,3-••--- ----------- q p• - 1 --------- Disposal Field: Distance from nearest well_.- -...Distance. from foundation_-,1 .--_�_-.Distance to neares; lot�line........ l�J Number of lines.-.._....'i....�_--.__ ___---Length of each lineaQ _ F__�h-----.Width of'trench. -.___ r D -_-_.Di tante o nearest Type of filter material......:::....... .. ..Depth of filer material.'---------------------Total length.------- _ [ De th-� Iot 4 l-e ------- See pa e Pit: Distance to nearest well.. .-__ _-__ Distance from foundation...,__....... Number of pits .1 Lining material-------- -Size: p . S Cesspool: l}istance from nearest welDistance from foundation-..:__....._...___.Lining material.... .............___...: �Y $ e: Diameter 1--- -•-Depth-------------- ---------------------I------------- Liquid Capacity..-�----------------------gals. ❑ --- -- :--Distant from nearest'buildin9--------- ---------------------- - Privy- Distance from nearest well----...._ .. l t _ F ------------------------------------------ _ •.-- i ❑ --------------------------------------- ------ _ Distance to nearest lot line...-___.�--------------- � I � e -, Remodeling anti/or repairing (describe): - ------------ -----.----•-------------- .� . _. r �•----•-� � ------------•---------- --------------- -- ��--�"---------------------- --------- ' ------ ----- -O --------------------------------- --------------- -------- -----.. ..----------------------------------------------------- .---------------------------------- .-..-`--....--'-----....._._'--.....----...._....._..-•____..-....-....-.--_....._-.._..-....---�d I hereby certify that I have prepared this application the San Joaquin t Local k will beDis done n accordance with San Joaquin County ordinances. State laws, and rules and gu Si ned d i, (Owner and/or Contractor) - - -------------------------- BY:----------------------------------------........ =f -----:_. f--------(Title)--- = (Plot plan, showing size of lot, location of system in relation to wells, buildings, et;., can be placed bn reverse side]. FOR DEPARTMENT USE ONLY d APPLICATION ACCEPTED BY --- --- DATE � .. ----- ----- -------------- " _V ."� -: �*------------ DATE----------------------------------------------------------- REVIEWEDBY-------------------------------------- ----- ----------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------e ------ DATE ---- -------------- --------------------------- 13-25-5 IlJz1 at�R ss------�V'T A►{---MASER fl�5 rPYcxv Alterations and/or recommendations:...__..... ---- .� - -unni3-F F©4Z.:.Abb �rs NASI E BE !•1PuRCH--sE� '� --- T< ------ -- 1 -c /k.R```L � -----5.6 -- -- -- 71/wt 1e fF ate- !' ---�ti-- ----%- " 4 rLt�t 4t FINAL, [NSP>CTION " - _C-ftF �.IOA�IN LU EALTH ICT A �, '{ J- 814 North "C" Street 130 South American Street 300 West=Ockttb��. ../ 132 Syca s Street -5��Jq Tracy, Ceiiforni . Stockton,Cilli di,inia Loalifornie !3",� JY41 Q �s� ✓ ,��r✓.�� asfr��a,��,sstrc�,*:Ir�o. ES-9-2 +e��lJl 1-57 .PoVgo) _..