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FOR OFFICE USE: ------ ---------------------'--------------------------- APPLICATION FOR SAWATION PERMIT Permit No. .__ __.. ----------------------- --------------- --- (Complete in Duplicate)- w Date Issued --------------------------------------.._.___._.._. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local-Health District for a permit to construct and install the work Herein described. i This application is made in compliance with County Ordinance No 549. JOB ADDRESS A tL. LOCATION /� ��'67 - //- a ff ��LfGi-'�/L v,��P I�� TH Q Owner's Name /` �6 - -h/_ �'-!`_�L�G- = Phone----- /7 Address ©1eJ r --------------- L tfCC !{� /1�CtQ. Contractor's Name-------- - -` ln---- _h -------� iv --------------------------------------------------------•---.-. Phone. (l! �?��1�_�,f Installation will serve: Residence ❑ Apartment House ❑ Commercial " Trailer Court ❑ Motel ❑ Other ,1f'e 1'4 �'�� Number of living units: -------- Number of bedrooms __ __ Number of baths Z- Lot size �.. --------••--- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -------- ft. 1 O Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ C3 i Previous Application Made: (If yes,date---------- __.l NckVI New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_�QIjf5_Distance from fou dation__AV0..__.__.Material---- __. i ----------- -- -----------------I;, _____Li Liquid de th____-S'•2- --- No. of compartments__' q p, rr_______Capacity-/2090-- Disposal i r Disposal Field: Distance from nearest wellA)GOCT._Distance from foundation_1P.-�...-__.Distance to nearest lotNumber of lines____ �__�.L. Length of each line__/�.1__ Widtll of trenc}�._ _ ._�-.- t----------Type of filter material ________Depth of filter material_._.._l__�_______.Total length__-__ ___ �___________-__.ir Seepage Pit: Distance to nearest well- �j_ _( __Distance omf undation_.Q{______.D totfe to nearest lot lineNumber of pits__4W_tj_-__Lining material_ . Size: Diameter.___ ...__-.._-Depth__��. ________________Cesspool: Distance from nearest well______.__.____-Distance from foundation____...............Lining material___-----.-______._._.___________E] Size: Diameter-------------------------- -----------Depth----------------------------------------------------Liquid Capacity--------------------------•-gals Privy: Distance from nearest well------------___--------------------__----------Distance from nearest building---._---------.____._________________..._. ❑ Distanceto nearest lot line ------------------------------------------ - ------------- -------------------------------------------- - -------- Remodeling and/or repairing (describe):•_ __ -------------- _ _ i�✓ ,�----- --- (J � ------------------------------------ ---------------------------------• _1---------------------------------- ---------------------------------------------------------------------------------------------- 1 hereby certifytha ave prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State s, and ru sand regulyrions of the San Joaq ocal Health District. (Signed) --- -- ---- ------- ------ ---------- (Owner and/or Contractor) t B -�- .�.d. -------- ----- --[ � {Title) --------- (Plot plan, owing size of lot, location of system in relat to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- --- - -- -- -- ------------- ------- ---------------------------------------- DATE--------- _ ------------------- REVIEWEDBY-----'-----------------------------'------------------------------------- -------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE------------------------------------------------------------- Alterationsand/or recommenda+ions:----------- ------------ --------------------------------------------------------------------------•---------------------------------------------------------- --------------------------------------------------------------------------------••---------- ----------------- -,- _ -a -------------------------------------------- --------- - ------------ - ---------- �-------------------_-- ------------- ------------------- --- -------------------------------------------------------------------------------- -------------------- FINAL INSPECTION BY: Date....3 --------- - -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffo:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I F.P.CO. I