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FOR OFFICE USE: ------------------ Permit No. ----- ----- ----- APPLICATION FOR SAMTATION PERM - (Complete in Duplicate) - --- --- I ,.,,.Date..lssued ..-- ------- -- --- `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. This application is made in compliance with County Ordinance No. 549. 1'�S8 t I-r S.�-�es�.a----df�'--19/V G� e- 'JOB ADDRESS.AND-`LOCATION.I -. J Phone�N.�y ------�/V Owner's Name----DE;----1.l-A-Fu-f114-------DA-W-.---- Address.-------- 1\..l.j..__ ----. _ �f-- ---- �}� rr Phone._ .Ilf 7AW Contractor's Name-------------------------- ) -- - Installation will serve: Residence % -Apartment Hou, .❑„Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � - � .. Lot size -- -- - ---"-- ..- Number of baths .Z Number of living units: ':-(_—Number of bedrooms . ,�� ft Wa+er Supply: Public system ❑ Community'system-❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand-❑ Gravel ❑Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ -' ' ' ---I No New Construction: Yes ❑ Nom FHA/VA: es ❑ C r . Y No [�, Previous Application Made:` (If Yes, ate _- rl�_ _ �.- — _ TYPE OF INSTALLATION AND SPECIFICATIONS:blit sewer is available within 700 feat.) (No septic tank-or cesspool permitted if..p r b '�-�----- -----Material-- ---- --- -- -------- --- ------------------- V -- Septic Tank: Distance from nearest well- 9--._.-.Distance from fou dation--/Liquid depth--$74-rj----- -....Capacity--/Z-Of------ I No. of compartments.._-� Size-._1-20Q-- - -- -- G i r Distance to nearest lot line-. .._.0------ Disposal Field: Distance from nearest well.__�-1l0...-._Distance fro foundation- 4•D -----Distance of trench----.�..... . ------ � Number of lines. Length of each line.-�Q-�-----t7- Total len th l 7 e- 1 I Type or filter matenal__ ______ ___ _ Depth of filter matenal---1-.. ___"-.-.-._- g Pit: Distance to nearest well-----.................Distance from foundation_...__._.-..._..---Distance to nearest lot line..---...--..-...� I Seepage . De th----------------- ' ❑ Number of pits----------------------Lining material---------- ------ Size: Diameter-- El ----- - p ing Cesspool: Distance from nearest well.................Distance from foundation_------- - --Li quid Cmaterial Eacit gals.* tDepth -------------------------- q P Y ❑ Size: Diameter-------------------------------------- p 't i Distance from nearest building----------------------------------------- Privy: Distance from nearest well ----------------��;�,; .- ---------------.-- v. ❑ Distance to nearest lot line-------------------- ---------------- ------ ` . ------------------------------ -------- ------------ - repairing (desribe}: 4- vie-6, ;-------- --------- _ - Remodeling and/or - -- -. ---------------- --------------- ----------- --- ----- I ------------------------------------------------- ---- ---- --- I I hereby certify that I have u es5aclpared thi application and that a work will be done in accordance with an oaquin oun y ordinances. State Laws, an regulations of the San Joaquin Local Health District. (Owner d/or.Contractor) ----------- A., i�C. (Plot plan, showing size of lot, location of system in relation to wel s, buildings, etc., can be place on reverse side). (C� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ------------------------- - DATE - r j ` ------ --------------------- DATE------------------------------------------------------------ REVIEWED BY--------------------------------------------- --------- ------------------ -- ---- ----------------- DATE------------------------------- - ---------------------- BUILDING PERMIT ISSUED------------------------ - --- -----------------,------------•----------- - ------------------------ ------------------------------------------------- Alterations and/or recommendations---------- -------- ------ --------- -------------- --------------- - - ---- f� l - - ------------------ ------`----- Date----��_�. ------:- �- FINAL INSPECTION BY-. SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street I -. Manteca,California Tracy,California Lodi,California '- Stockton,California F.P.0 LL ..