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1 / APPLICATION F-511 S9NITATION PERMIT Com 'fete in• Duplicate) t I 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. "a X ' JOB ADDRESS ANOCATION. ? ---------- ----P41r 1� Owner's Name----------7--�" V Phone-------------- _ -, 0. Address ------------------ �l a� � ----•-- -- r,I Contractor's Name----------------------••----------- "- WAr A'H1 - Phone - - -------------•---------------------------•--- ` Installation will serve: Residence Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _+ - Number of baths ._____ Lot size ____________________________________________________________ ' Water Supply: Public, system ❑ Community system 0 Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: YesA No ❑ FHA/VA: Yes ❑ No 1 r TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank ar`cesspool permitted if public sewer1sfavailable within 200 feet.) Septic Tank: Distance from nearest well Distance fro fuclatian 10-------Material------l----d''��#'4"� 7 +e,' No. of compartments `, ._Size . Liquid depth Ca aci 9e� P tY -- Disposal Field: Distance from nearest w II _'--`:-_..._.Distance from foundation---f��stance to nearest lot line_____.+5�___ Number of lines_____________ -__ __,______ Length of each line- __'r�C+�, idth of french-------`�.__�1 _-- d -- Type of filter material--------- - -- ---------Depth of filter material-----jF-Y-__-_---Total length-------------�-1,�____•-,-----�•_--- Seepage Pit: Distance to nearest. II ______- ___Distance fr m f undation__ pieta ce to nearest lot ❑ Number of pits----------- Lining mate ria l_ A __-Size: Diameter_ ------------peptn__ _ J Cesspool: Distance from nearest well-----------------Distance from foundation---------_______---- Lining material__.___.__________---._______________ G ❑ Size: Diameter--------------------------- ------Depth:: =------------------ 0. ------ = Liquid Capacity ---gals. Privy:, Distance from nearest well-------------------------------------------------Distance from nearest building I--- °'�-A ❑ ' Distance to nearest lot line----------- ..�. ., -- ------------------------- --------------------------�----------- -- ----- ------------- ----- Remodeling and/or repairing d scribe):________ __ _______________________________ ------•--------------- ----- -------------------------------------- - ✓ -- �� -- , �. -----------------------------------------------------•--M--------------------------------------------------- ------------------ ---- --------------------- I hereby certify that I haus prepared this application and that the work will be done in accordance w4th�San Joaquin County ordinances, Sta F�ws, and rules and r guiatioris of the San Joaquin Local Health District. (Signe a ` ___.__.____(Owner and/or Contractor) ` -- ----------------- --------------------------------------------- •- B : --------------------------- " Title ---------------------------------------------------------------- (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------------ DATE - REVIEWED ATE REVIEWED BY ---:--•--- - DATI= ---- -- -- ---------------- BUILDING PERMIT ISSUED_____________________ )_- �` ----- ------------------- -------•---------------- - ------------------ DAT . on tis and/or recomm ndations: - , Altera ar _,4�_ `� -•----------------------- ----------- -- --- 75 --------------------------- AvinPT:�. ---- 7r �. FINAL INSPECTION BY: ' -- f,.:------ :--a_ �, , . Date_.. ---------- __ SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ReviseG 1.57 F.P.CO.