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APPLI*ATI*N F® ANITATI®N PERMIT Permit No. 11` [Comp� �R plete in Duplicate) Date Issued i 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 Counryrdinance No. 549. JOB ADDRESS AND LOCATION_..I��-�---- --- -`-�-�---------------- ---------------•-------------------------------• ----- Owner's --- ,q Owner's Name CU J Pd1i{ ------------------------------------ ------ Phone._�--------�'- - 6 Address 6 ...... .-_-•-----.---•----------------------------------------------------------------------•-•-------------------------------------------------------------------------------- 74-� Contractor's Name- - ) )U1 ---e----------------------- ------------------------------------------------------------------------------ Phone.94....3"JC- ------- Installation will serve: - Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo el ❑ Other ❑ Number of living units: __9_____ Number of bedrooms '__. Number of baths ___�_.- Lot size ._.__�_ _� __ 1 -- - Water Supply: Public system' U/11community system ❑ •Private ❑ Depth to Water Table 7= ft. Character of soil to a depth of 3 feet: SZNew d ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay C] Adobe P-- Hardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes 0"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic T nk: Distance from nearest well__,-----------------Distance from foundation--------------------Material__________________-____.___--___-_______--. E etN� No. of compartments------------------------ Size--------------------------------Liquid depth-------------------------.Capacity---- - -- -------- Disposal Field: Distance from nearest well------------------Distance from foundation-----------------....Distance to nearest lot line----------------- t� Number of lines------- ------Length of each line-------- ----------------.-.Width of trench------------------------------------ Type ---------------------------------- F ! Type of filter material------ Depth of filter material._..._________.-..__.Total length_________________________________ _ Seepage Pit: Distance to nearest well___ _Q �- Distance from foundation____.--------Distance to nea st I ---_.. j i Number of itsLinin material_ Q !.___..__.Size: Diameter._.-_ .Q_.-...__..Depth__ ________- p -------- 9 F czz�%5 � Cesspool: Distance from nearest well-----------------Distance from foundation----------------..-Lining material__.__------------------------------- El __- __.____.____.___________❑ Size: Diameter----- --------------------------------Depth_------------------•----------------- ----.--------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building.___._____.__.__________________--__-__.-_ ❑ Distance to nearest lot line----------------------------- ---------------- ------------------------------------------ -----------•------------ Remodeling and/or repairing [describe]: y •-•-----. -. ----- -- ---- ----------------- --- ---------------------------------------------------------------------------------------------'�-_ - °`�`--- :____:::__... `--`�__::_ :_____:::__: _______________-.._:::__::_------------------------------_---------------------------------------------------------------------------------------------------------------------------------------- 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 laws, and rules and regulations of the San Joaquin Local Health District. r l (Sigrse� I) (Owner and/or Contractor) l ) By:._..` �`�°'4-,. = -------------------(Title)__.— - ------ (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on revere). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - ------- --------- ----------------------------------------------- - DATE----- BY-------------------------------------------- --------- -- - -- ------ DATE------ ------------ ----------------------------------------....PERMIT ISSUED------------- ------------ - DATE -,.`f Alterations and/or recommendations:.----- .... ------ --- . -•--------------------------------•-•--•----------------------------------------•-------------- ----r ------- .... ___________________________ _ __ _______ ____ __ __ _ —�___.._ __-- ( r pM�_______- i .._ . _.. ..-C2.- -- ---�-------- -_- ' '�------- ----------- --------------------------•-.----------- -- -- ------------ - � 7 FINAL INSPECTION BY:- 1 -------------------------------------- Date----- ..... - ------------ --- --------- ---• ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT I w � 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES�4 14s449 ATWODD