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APPLICATION FORONITATION PERMIT Permit No. d 41, ( . _(Complete in Duplicate) Datil Issued- --- 4 Application 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. 549. JOB ADDRESS AND LOCATION_____________________________-__2196Be Ash St- 4 __ ------ Owner's Name------Al llandS'o—and.-Lup.0.-- %> _ _ - - - ---------------- ----------------- Phone---gge '"►3f 77•-------- Address---------- ------•-----•--•-------------•----------------------------------;--------------------- ------------•--------------•---•--------------- Contractor's Name-.--�--P.011A-------------------------------------------------------- --------------. Phone.HO'--3w�727--- ----------------------------------------------- Installation will serve: t Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ MoQh Other ❑ Number of livi+ units: ---1- Number of bedrooms ----2-- Number of baths -3____ Lot size -------3_Q q`_---------------------------------- Water Supply: Public, system Z] Community system ❑ Private ❑ Depth to=Water Table 45_. ft. Character of soil to a>depth of 3 feet: Sand;❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g Hardpan ❑ Previous Application ado: Yes ❑ No [�: New Construction: Yes ® No Q FHA/VA: Yes ❑ No [IC TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Di�tance from nearest well________________Distance from foundation....................Material--__--__-__---_._.-----___•----_•_----_-______- Exi"ing N9. of compartments--------------- ------Size--------------------------------Liquid depth--------- ------ ---------Capacity------------- ------ Disposal Field: Di tante from nearest well_________________Distance from foundation.................... to nearest lot line-.-•__---__.____- Exi®ting N mber of lines___________________________________Length of each line---------.--------------------Width of french----------------------------------- T e of filter material_________________________Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well-A9_Al_-_-_Distance from foundation___ggat_.Distanceto nearest lot jine__5_t _ _. -_____ N imber of pits----------1---------Lining material....__1'_DAk-----Size: Diameter------_....33"_____Depth---- 5-------------_---------- t Cesspool: D stance from nearest well-----------------Distance from foundation--------------------Lining material_-___.__-____-__-____-_-_-______. ❑ Si e: Diameter-------------------------------------Depth----------- --- .---- } Liquid Capacity ------------- --------gals. Pri Distance from nearest well _-______ _______ ____ __ :_-____-Distance from nearest building------------------------------------------ -# t Distance to nearest lot line-------- ------- ---- - -- ----- - ----------------------------------------------------------------------------------------- Remodefincj-and/or repairing (describe)_------------------------------------------addiniZ s_1"_ep � ��.� t� t�7Clstill�, 8�f8t@m ------------- I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------•-=� --------- -------------------------•=•----------------------------------------------------------------------- ----------------------•---•--- ---------- ----------------------------------------------------------------------------------------------------------------•-------------------•-------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat l ws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- ;a,'j'AA)K--- QrT--}--- --------------------------------------------------------------(Owner and/or Contractor) By:-------------------L.--•--Perm-- fa2rthaa. (Title)- G---e---n--,- M8r, ----------- (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 is ...,...�..... ... APPLICATION ACCEPTED BY ------- ---------------------------------------------- DATE = ------------------- �- REVIEWED BY - DATE. --•--------l--------------------------------- BUILDING PERMIT IISSUED--------------------------------- -- --------------------------------------------- DATE----/ -'=�------------------------------------------ Alterations and/or recommendations---------------- -- --------------------------------------------------------------- ------- ( ------------------------------------------------- - ----------------------------------•-- ------------------------------------------------- •--•--- FINAL N,SPECTION BY:.--- ...M----- _ .____� - ------ -- Date---7�-. ---- `� s SAN JOAQUIN CAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F.RCO.