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FOR OFFICE USE: so, --i---------- ------ ------ _. ''-_ "................//� ._.___ APPLICATIONµFOR�SA�VITATION PERMIT Permit No, f l� /...: e--- " �- _- a--- 'cam'------ a Complete in Duplicate) - -. --------------------------- - -- --- This Permit Expires 1 Year From Date IssuedDate Issued 31'04� -.t, y tff 51- Application is hereby made to the Sari Joaquin Local Health District fora ermitto construct end 'install the work her in described:' This application is made in compliance with County Ordinance No. JOB ADDRESS WOCATION ----��- Owner s•Name-•_•,..__ °�-- .. ,. . � � Phone __ __.___4.___ __ _____ _ __ _ ______ __ .___ _._.._ ._ Address : ----- -- --- ---- ------------- -- Confiactor's Name__________________________ - PhoneAWc7 F h Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: ----- - of bedrooms I 1_` t �._ Number of baths __�-Lot size ��5��.._ __�_ � � F Water Supply: Public system [ ICommunity system ❑ Private ❑ Depth to Water Table _&,oft. Character of soil to a depth of 3 feet: Sand (] Gravel E] Sandy Loam ElClay Loam E] Clay E] Adobe K Hardpan'(] Previous Application Made: (If yes,date--------------------) No [K New Construction: Yes ❑ No X FHA/VA: Yes ❑ No P TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerryis�available=within:200-feefo)*w• q Septic Tank: Distance from nearest well 009,Distance fro foundation---Z__-1--material--- No. ___._.Material__. No. of compartments p g Liquid depth----- --------- ---------Capacity �•7,�� s l Disposal Field: Distance from nearest well .l�6��"-Distance from foundation__ P__�_.._.Distance to nearest lot line_✓'.____.___ [ Number of lines�.....�_. ._ (Length of each line__CS'__0,6---_-Width of trench-W-4.Type of --------------------- filter, matena!__ Z___._ _ Deptla,of.filter material___. __ ____Total length_.-__-_.�`�'�______.__.__-______.. Seepage Pit: Distance to nea est well ° -___ Distance om f undation___ Q!. ._.Dstanie to nearest lot ine--- -------- [ Number of pits. 2 .........__Lining mafierial._ . 'L _.Size: Diametr. ....__Depth___, :5_____________________ i Cesspool: Distance from ne arest well----------------- from foundation------------- .....1p ing material-_'____---.___._--.__-.-_-_----____-- Size: Diamete I_c�. De thI = I Lid uid Capacity-. gals.. ❑ --------------------- p p Y-------------- --- g ]]� . Privy: Distance from nearest well-___-. .-- ----------------- - DIst.ance�f.rpizInearesf building._-. --- ____________ ___ t y� ❑ Distance to nearest lot line --- ---------------------------- • --------------- I ---_- --_ g repairing { _ __ __ _! _...._-_ .. _._.. --•T___________ _____________._,___-_.. __-____-.---------------------------------------------------- ------ `__.__--.__-___---_._____-.-______________-__- Remodeling and or re airm describe]:__.._ -_ I -- ---------- i .,r ------------- -•--__------- --------------------•--------------- 1 -------- - --------------•---- = = -------------------------------------------- . -------------------------- --------------- -- - ------------ - - ----- --------- -- - - - Ihereby certify that I have repared this plication and tha he work will be done in accordance with San Joaquin Counfy` i ordinances, State laws, rues nd3 a tilati' s of t e San Jo n LOe'aI Health District. (Signed------------------------- c ----------- --------------- (Owner and/or Contractor✓ BY: ---------- -(Title,- ------ - ` ---_- {Plot plan, showing size of Io , location�af system irt'ielatio 'to w-ells;-bwldings, efc., can be place n reverse side). 3 r, FOR DEP ARTMENTfJSkONLY APPLICATION ACCEPTED BY------- � - �"., - ------------------ ------- DATE------Wil = ---------------------------.._ REVIEWEDBY----------------------------------- x --- ------------- -----------------,-=-----------------------------------.--- DATE)------------------------- BUILDING PERMIT ISSUED. - - _DATE ------------- Alterations and/or reco mendations� ---------------------------------------- F f/ 2 �3-------------------- - -----------------------------------------� --------------- ---- -- ---- --- -- - ------------------------------- - = 1'- _J�._ ---------- FINAL INSPECTION BY.-.--------- -------- -------------- -------------- Date-------1/..-2. n= �i SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ;1 Stockton,California Lodi, California Manteca,California Tracy,California 4! Il I'