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00 APPLICATION FOANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -----r!_I_--Z Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. d. JOB ADDRESS AND LOCATION 4'_ Owner �� -----• ----- -----bS ----- ------- -- Address__ -- .. ------------------------------------------------------- ----------- hone T --- f �Ae-- - " Contractor's Name_ `nn �:. - --------------- ----------------------------- ---------------------- Installation will serve: Residence Phone__ -_-- "_-- _ 1� f'+partmertt House � : -" - - •----------- -------- ❑ Commercial ❑ Trailer Court ❑ -Motel Nbr ber of living units: _� Number of bedrooms 'Ln. ❑ O�her ❑ Water Supply .Public system �ommunit Number of baths ._1___ Lot size .__ ____ r � 1 .- sstem •---•----- --•-------- �---- Character of soil to a depth•of 3 feet: Sand ❑system ❑PrlSand❑LoaDepth to Water Table _ _"_ f}, Previous Application Made: Yes ❑ No y ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ New Construction: Yes Nr'.No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet,) Se tic Ta p � �. Distance fro_m nearest well No. from foundation---------of compartments--.. -- -----.--Material------------------ ------Size-------------------------------Liquid depth---------- Disposal Field: Distance from nearest well______________ Capacity-_____.__-__-- .". istance from foundation-----------_--------Distance to nearest lot line"------------- Number o{ lines--------------------------- Length of each line--------------"- Type of filter material----------------- Depth of filter material__"-- - Width of french---------------------------------•- ---------- ------.Total length----------------- ........................ eepa pit: Distance to nearest well_+► � ---_-_Distance from foundation__. : v Number of its.____ �"` .±ZC,Dista�ce to nearest lot fie_-�------_ P �---------"-_"--Lining material_ .""-_-- - Cess ool: Size: blame r-_.. --------- .pe�th_._a-cS."- p Distance from nearest well---- ---------- ---Distance from foundation--------------------Lining material--.--------------- ❑ Size: Diameter-- ---------------------------------Depth-------------- {� ------=------- ------ �------ ------Liquid Capacity-- ---------•- �T Privy: Distance from nearest well---------- -------------- --------------gals. ❑ Distance to nearest lot line..._____.. Distance from nearest building"-" Remodeling and/or repairing (describe): ----------------------- ----------•------- --------------------------•----------.---- --- --------------------- -:::::::::::::::::::::f::::::::::::::::::: ------------------- I hereby cery-sltat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateate laws. an(d�rules and regulations of the San Joaquin Local Health District. (Signed)------ "' -c1 iz, --------- �, Ioc(af ---•--- ------- -------------------------------- ----------------------•-- -------------------- By:__--_____-" Owne and/ r Contract- 0. •------------------- ------ -------------------- --------------------- --- ----•-(Plot plan, showing loion of system in relation to wells, buildings, etc., can be laced on - ------------------------- -- Contractor) cle -------------- P revers ide}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- DATE- ---REVIEWED BY ------------- ------- - --- -------- BUILDING PERMIT ISSUED �---- -------------------------------------- DATE----7------- _ Alterations and/or recommer d tions:_-------------------------- " .,_ �` , DATE--- -- -- _--------- r _ r1 -=- - -------�-------- s. ---------------- --------- -------------- ----------------- •-----•------ FINAL INSPECTION BYi__-""--.-_----. -� " f _� / A � ----- ate-------------- - - I r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street$tock+on, California 132 Sycamore Street 014 North "C" Street Lodi, California Manteca, California- Tracy, California E-9-9-2M 145446.,TWOoo �2-54