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I FOR(FFICE USE: e v --- -------------------- ' -- _`_______________________F' _-_ APPLICATION FOR S11rATION PERMIT Permit No. � h j---------------------------------------- (Complete in Duplicate) -----------------L.................I-----------------r... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru and install the work erein os rbed. This application is made in compliance with County Ordinance No. 549. r> JOBi�ADDRESS AND LOCATION--- rl � _.. � -T---`�-A....- ---------------------- Owner`s Name '�J�L � - ----- G ------------------- ------ Phone_141-V w` 1F Address................... ------ ----•----- ----------------------------------------------------------------------------------------------------- ------------------•----------------------- ContFacfor's Name-----------. --------- --------•----------------------------------------------------------------------------------------------- Phone-----•----------------_--_------- I Installation will serve: Residence [q`_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms __-- Number of baths -I._ Lot size ------ v `y—`� --------------- Water Supply: Public system ❑ Community system V<vate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand p Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El Previous Application Made: (If yes,date./ r� ) 'f�o�❑f Nlw Construction: Yes M--1'4o ❑ FHA/VA: Yes ❑ No ❑ TYPE, OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Sep^tic�T Distance from nearest well-_47c'.__Distanc from foyndatioA--------------------Material--. �-._' J''��r`._ l_ Ca acit No. of compartments_-__. __.._._..__Size____ 1i%_ ___ igwd depth____._._____'_ p y Dispasal Field: Distance from nearest well-...1-0.__Distance from foundation -------------- _____ Distance to nearest lot line._` /___le 12-f Number of lines____________ Length of each line___ �-� ---- ---------Width of trench------------ --- -•---- Type of filter material.___.;ed_4k.<Depth of filter material----- length-----�l t� ______-___--__ Seepage Pit: Distance to nearest welt-----___--------------Distance from foundation------------------- Distance to nearest lot line_________._____._ Number of pits---------------------Lining material----------------------.Size. Diameter------------------.----Depth-- ------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation----------.----- g Linin material Q Size: Diameter----- -------------------------------Depth--------- ------------------ ------ - ---------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------__----_--_________________.._._. LiDistance to nearest lot line--------------------------------- ---------------------------------------------------------- ------------------rl---------------------------- Remodeling and/or repairing (clescribe):_---------------------- ------- --- --------------•--------------------------------- ---------•-------------------------------------------------------- --•----•---------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- r------- ------------------- --- ----------------------------------------------------------------------------------------------------------------------------------------•--- --------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rule's and regulations of the San Joaquin Local Health District. (Signed)•-- 1 --------------------- ----------- ------------------------------------- -------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(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------ll-(r -------- ��------------------------------------ DATE----- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE-------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------- --------------------------- AJteretions and/or re ommendations • r ._. `-V[3----e--------- --�` -f�R'r, ----- - -�"�-H'r[-------- ,- -------- -------------r-' -�-I -r•----------------1------•----------------------------------------------------------- / !/ 1 + { e+tr {�w tit - - ------� ets.�f�� ` `� � ...... o ------- - -- , ------ ----------------- ------------ --------------------- ----- - - ----- ._.:_-::------- --- -------------------- -------------------------------- -- --------- FINAL INSPECTION BY:. - :.� - --- -- ----- ---------- Date.----��= � `� - SAN'JQUIN LOCAL HEALTH DISTRICT 160x.E.Hazellon Av*, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F•,a.c o.