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APPLICATION FOk_,:._ANITATION PERMIT Permit No. ----- (Complete in Duplicate) Date ' Applica+ion is hereby made to the'San Joaquin Local Health District for a permit to c nstruct and install the work herein described. ; This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 2445 Cherokee Lane, - F____________ ------------------------------ - --------------------------------------- ------ Owner's Name.--•----•--•Cl Ci--- LPC ,--- PhoneH_0------3��------- ---- S�!R C th e . . Address------------------ -----------------------------•----------------------------------=--------------------------- ' Contractor's Name D- � �---Il-- --------------------------------- ---------------------------- -- ------ E - Phone �i t Installation will serve: ,Residence 0,C Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---!Ji Number of bedrooms 2----- Number of baths ----1-- Lot lsize .-.50---'x---20 ---------------------- - Water`Supply: Public,system Q ;Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa� ❑ Clay Loa Clay ❑ Adobe[ Hardpan {] Previous Application Made: Yes ❑ No Q New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 + ^ !(No septic tank cesspool"'ermi+ted if public sewer is available within 200 fee+.) r Septic Tank: Distance from nearest well-----------------Distance from foundation---------------___.Material_--______§___.___- ----------------------------- -.___---------:___---__. mems--------------------------Size--------------------- l---- -Liquid depth------------ - - _------.Capacity.------------ ----------- Disposal Field: Distance from nearest well________________Distance from foundation 4 ! BX��in No. of tom art ______________;.._.Distance to nearest lot line_______..___._._. ex[ ,ting Number of lines-----------------------------------Length of each Ifne------- .-- ----------..Width of french---------1------------------------ # Type of filter material-------------------------Depth of filter material__------------ -- -.-Total length---.---------- r__._.__._.____._____------ Seepage Pit: Distance to nearest wel!_.__nfl._... Distance from foundation----- ----.. ._..Dista;ce to nearest ]of lline_r,#_, ------ . Number of pits''....... ............Lining material._br' C�____Size: Diameter-_.------3-_--------Depth._` ._✓±-�__��;r�'� Cessol: nearest well-----------------Distance from foundation_____:_____-__t___.Lining material---------------- --.----_---_-_----_-. ❑� Size; - D am efe-------------------� - -----.Depth------------------------------:------ -------- I---Liquid Capacity-.------- -------------- -gals., Privy: Distance from nearest well--- ---------------------------------------------Distance from nearest building__________ = ❑ rest lot line.-..-" ---------- ---- Remodelingand/or repairing desc - 3 � I • it T ------------------------- -------- � -Distance o Hera ribe 2ddin_ v.ertici~l__dr�in / p g - . - - - - .. . - - ----- ------ _ . f i -------------------••---------•--------------------------------------------------------------••-----------.-...... -•-----...---------•--------•--------------------------------------------------------------------------- i --------- --------------------------------------------•-----------------------------------------:-------------•---------------------- --------------------.----------------------•-- . I hereby certify that I have prepared this Applica+ion and,+hat..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. yOwner and/or Contractor --.._•--------------------------------=-------------------.;� -----------------------------------------------------------------:--------------------( / ) By:------------ -Pw----------------------------------`--•------------------------•-------------------' -------------------(Title)-------h4nx.---------------------------------------------- (Plot plan, showing size'of'lot-, location of sys+em4n'relation to wells, buildings, etc., can be placed on reverse side). i "FOR DEPARTMENT USE ONLY � ACCEPTED a DATE-R4 REVIEWED APPLICATION B ._ .__ _ - ------- DATE al -------------------------------j----------------- BUILDING PERMIT ISSUED___-...._.. -_ DATE..__.__ ________I ,- ` ---------------------------------------------- ----------------•:------------_------ Alterations and/or recommendations------------------------------------------------------------------------ - I ~- !. "a -------------------•-- ----------------------- -nth---. . � .� � �..� �?� _�? �-- �- --------------------------------- -------- ---- __o -- ---------------------------------------------------------------------------------- 1 t FINAL INSPECTION BY:..' ..-_2, Is 14� Date--- _ v Y � ------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 3, ES-9-2M Revised W-2100