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FOR OFFICE WSEI ------ Z _--._-_- -:_-_________--a)-s47. ___,� APPLICATION FOR SANMATION PERMIT Permit No. ....1. Z....... ------------------------------------------------ -------- (Complete in Duplicate) This Permit Expires 1 Year, From Date Issued Date Issued a . y..i-a Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe work herein described. This application is made in compliance with County Ordinance No. 549. [-7 JOB ADDRESS AND LOCATION--�f!''1f---- ..... Owner's Name gr¢C.�4_- ---- ---- -- -•- ----------------•---------------------------------------------•------------------------ PhoneH.Q__��_.... .. Address-----fes '�--------5 -A•-.... •- -• Contractor's Name ---�---J-------- •- Phone Installation will serve: Residence Qd Apartment House ❑ Commercial E] Trailer Court ❑ ¢¢Motel Otheer,, ❑ Number of living units: _1_____ Number of bedrooms _ Z___ Number of baths ._-1___ Lot size ----- Q__C-_-____- ... ..`_.. ..r...(l.......... Water Supply: Public system Id Community system ❑ Private ❑ Depth to Water Table SO.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date-"- -.-} No ❑ New Construction: Yes 2r- No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___ ___Distance fr m f undation._._-J Q._.. Materia!_`$y ._ .... ......... ...... N No. of compartments-------Z►-------------Size___-,5 ----` _ --Liquid depth----__C/-------__------Capacity_--$_Q._C2__- Disposal Field: Distance from nearest well----3_0 _Distance om foundation ,j.2........Distance to nearest lot ....... Number of lines............. --------------------Length of each line________5__ ---- _.__Width of french�y_._ ____ Type of filter material._Z_�� .__Depth of filter material•./-g-_'________Total length......P_�......................... SeeRe Pit: Distance to nearest well____-_(5�_(.-_-___Distance from foundation_____J_a__ _.Distan �to nearest lot line______ Number of pits----------i-------_.Lining material---------------- 3... -------Size: Diameter-•- -----------•Depth.-• --' •-------•-••-•- Cesspool: Distance.from nearest well----!............Distance from foundation--------------------Lining material_______.-___-_-______-_____________-_ ❑ Size: Diameter--_------------------i------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------- -------Distance from nearest buiiding------------- --_--______--_-------------_- 5 ❑ Distance to nearest lot line----------------------•----•------------- =7!t------------------------------------------------------ -----------:______________----------- I i Remodeling and/or repairing (describe): V•---�---------------------------- ----------------------------•-•------•-------•--•-----------••--•-----------------------------------------•--•------------------------------------ ----•----•-----•-•----------------------------•-•---•---•-----------------••-------------•-------------------------- ......•-•------------------------------------------------------------------------------------------------ -------------------------------------- •-------------------••--------------------------------------------------------------------------------------------------------•------------------------ .---- --•--•--• --------- --•- r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County1 ordinances, laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- --- --•- - Owner - --------------------------------------•--•--•--•---•--•-----•--•------•--••--•--•( anelli,o'r'Evntree#Ar) Br--------------•-- ---------- - --------- ----------------------------------------------(Title)------------------------------------------ - - --------------- (Plot plan, showing size of lot, location of system ' relation to walls, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----r.�.a-t)--- -------------•------•----------- DATE-----s w REVIEWEDBY-------------------------------------- ------•---•--•---------------------------------------------------•----.......-------- DATE • .... ------••------------- BUILDING PERMIT ISSUED--------------•---•_--.- _ ------- -----_ - Q T Aiterations and/or recommendations:______. __ __ Q +--4<2 ---�- .•••-•---•-•--•-•-- �- -------------------------- 1 ------- -------------------- ----------------------------------------------------------------•-•----•---- ---------------------------------- ••----------- ----------- ---------------------•----•--•----------- -------------------- •-------------------------•--• FINAL INSPECTION $Y:. 4T_�- 'Zk` Date (-�--`--........!---- -----------------------------•----------------•-- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ed 9 REVISED B-59 RM 6-61 ATGAB