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APPLICATION FOANITATION PERMIT Permit No. _-_-.�-�--1-l-- Com lete in Duplicate) II � li P P � Date Issued ____�l-1 l/o Applica}ion 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. 544. JOB ADDRESS AND LOCATION.--------------928x.----Cax�-roll---------•------- ------ Owner's Name---------- H. grBiB.------- Crbert--gr i-s---------------------- --------- --------------------- ---- Phone__ �___2.R --------------- ---------------------------------- ��' ---__. Address :. - roll-------------•-------------------- -------- ---------•--------------------•--•-------- -------------- ---••- Contraciror's Name----�DlIlim,,_IAC-------------------------- ---------------- ----------------- ----------- ------- Phone 126 ------ s i Installation will serve: Residence:E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:!______ Number of bedrooms __ _.. Number of baths ---k- Lot size ------3P---x_ l5 Water Supply: Public system ❑ Community system ❑ Private g] Depth to Water Table40___ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [ICiay Loam [IClay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes [I No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation----------------------Material------------------------------------.------.____. Eiisting No. of compartments--------------------------Size--------------------------- ---Liquid depth----------------------- -Capacity----------------------- Disposal Field: Distance from nearest we€I.................Distance from foundation----------------------Distance to nearest lot line.....__.._______. EnstingNumber of lines--------------- -------------------Length of each line---------------------_-------.Width of trench----.--.--------------------------- Type of filter material-------------------------Depth of filter material....-------------------Total length___-____-_______--____.._________--_..__-. ' t Seepage Pit: Distance to nearest well---s51-----------Distance from foundation__AMP-1—_.Distance to nearest lot lint------- _______ Number of pits---------1----------Lining material ---------Size: Diameter--..33.1-----------Depth------.-23.------------------ Cesspool:` Distance :from nearest well________________Distance from foundation------------.-_ ----Lining material--- ----------------------------------- ❑ Size: Diameter------ _. ---------------Depth----------------t--- ------------------- ---------Liquid Capacity- ----------:---------------gals, Privy: Distance from nearest well--------------------------------_--------------Distance from nearest building-____..____-.__--_-.-.-.._ ❑ Distance to nearest lot line-..---- - -------------------------- ---------------------------------- ---•---------------------------------------------------------------- 3,0 ------- ,Q Remodeling and/or repairing (describe):___add A9.__%eePege:-_pia-__'to__.t�►►ke---vase---oP--gash-wader onz ---Kreie._ hat i,nst l�.ing--the---e..... -pl .-55---(.f1ftV_-!-fiPe ..__feet----from---the-Ix__ solp1y--- heir__re pon ib .lity mnl .---- -- ----------------------------------------------•-•-•---------------------------------- ------------------------------------------- ------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) AC3 .f,_. _ p :h4 ' g...'�Cr91CQ:s _= 11C. :------------------- ------ ------ (Owner-and/or Contractor) --- aen Mgr Perry Warthan Tale • By: -------------- ------ ------- -7 = ( ' 1 = (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- -------------------------- -- BY-------------------------------------------- -- - DATE - DATE--------- -- DATE = �BUILDING PERMIT ISSUED------•---------------------------- mo - ------------------------- Alterations and r.r comndfi ------ --- --- --- ---- ---------------_ -----------------------------------------------.------------------------------------------------- -------------- ---------------------------------------------- --- FINAL INSPECTION BY:--- „�----------- --------- --•----- Date-------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerio'an Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9 1554a6 ATWOOD