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_ _ - Permit No. APPLICATION FOR ! ' ANITATION PERMIT _____-- (Complete in Duplicate) Date Issued .._._-!._.Z 3 --------------------- This Permit Ex ires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Pp , This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----_47-35•----•-- f�1..�- - n - ----..--------- Owner's Name------+ 44--------- -K.-EA Address... --------------- RIO.4..15(_.0 Q:1 Contractor's Name-----•--�.1_�.-•-----��,..�"�.1-�•:--.�----��"-l�,�r------•-�-�.�z.-_:..-----•---------•----- Phone--'Other Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Installation will serve: Residence 0' P � -(�[� ,g,---._•...................... Number of living units: ---I--- Number of bedrooms _� ---- Number of baths _- Lot size ------- Depth ro Water.Table .k,0 ft. Water Supply: Public system ❑ Community system ❑ Private Q� Dep Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y No 0 �+ plication Made: (If es,date-------- -----------) No l� New Construction: Yes ❑ No FHA/VA: Yes ❑ 4 Previous App' y v TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Vl Septic Tank: Distance from nearest well-----------------Distance from G foundaton--------------------Materia------------------------------------------------ n "._- .-.-....:-'-..._- ❑ No. of compartments-- -..".- ---�---1.-Size--------------------------------Liquid depth-- --•-----------------•-CaPact� - _ _--- Disposal Field: Distance from nearest well_--_a"Q------Distance from foundation ::Widthcofttrench est lot liA�- .--..:-- Number of lines-._------••--- ------------------Length of each line---------= -- 19�� TYPe of filter material._. ° �--"---•Dep#h of filter material-------1 �`•----Total- length------------•-------. z Distance to nearest well-10`0-"�-------Distance from foundation"__. )..j----.Distance to nearest lot line-.__._- Seepage Pit: / -3-4--•--DeptK-=-------•---''� `� �------ GOL) Number of pits.--"- --- Lining material.?.O--=------n" Size: Diameter-_-.--- nearest well------- ----------Distance from foundation-------------------- Lining Liquid aerial Cesspool. Distance from gals. F1 Size: Diameter--------------------------- - Depth Distance from nearest well-----------------------------------------------Distance from nearest building----------------------------------------- I ❑ Distance to nearest lot line------------ --------------------------------------- -----•-------------- 4 ---- - I Remodeling and/or repairing (describe):-_........0 Cl�cd x-�c S-T!wt_�_-..----- •% ----------------------- ------•------------ - -- ----------------•--------- ------ --------------------------------------------------------I......-----------I-----------------------------------------------11- ------•---••----------------•----------------.----- •••--...-._---------------------------------•------•------------•----•-------- I hereby certify that I have prepared this application alt the San Joaquin LocorkHeall heDis ridone in accordance with San Joaquin County ordinances, State laws, and rules and regulations n p ------------------------(Owner and/or Contractor) I 51 ned -i.. ..--.-p-• - ' ( ..-_ "g. ------------- _-----------------` 1 •g }-•-------- --• -.-- ----- - -- ----- - - ----- •----- ---------- ---- -- ----•--(Title)-----•-------- -- ------------- - -- ------- - aY � (Plot plan, showing size of tot, locatt n of system in relation to wells, buildings, etc., can be placed on reverse si e. i FOR DEPARTMENT USE ONLY - ---- -'-`--�=---------------- -- DATE_.-_��........ - APPLICATION ACCEPTED 13Y_--__ __ _ .-,---- --------------------------- REVIEWED BY------ -•------•-------- ------•- -----•-------------------------------------------- ----------•--- - DATE_. DATE i BUILDING PERMIT ISSUED------------------------ - -- . ---•-------•--s — c! '?`'` --` Alterations and/or recomm ndations:------ �`" `' --•---------------- •--- � ... ! •-------------------•-------•--.----- _ _ _t --------------- ------------------•-------•--------- ------ ----.. - ---- --- ---------------------------I------- a 7, ---------------- - -- - ------- ------- -- FINAL INSPECTION :..---. "- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 Wool 9th Street 130 South American Street 300 West Oak Srre+t Tracy,California Stockton,catifornia Lodi,California .. Manteca,California E5 9 REVtaeo 5-99 2M 5-62 ATt-AS