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p 'APPLICATION FOR NITATION PERMIT Permit No. ...I_�7.1.._6 (Complete in Duplicate) ! This Permit Expires 1 Year From Date Issued Date Issued __71.1/411 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---- 2618 S. O'Dell -- Owner's NameB Phone-----H°r----Z 69_ enn i e---C a-az t a------------ Address2618South �t-DeZl----------------------------------------------------------•------- ---------------------------------------•--------•---•--------------- Contractor's Name _. EClank_- zVCx 1 .Delta ---------------------------------------- Phone--------- � Installation will serve: Residence K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms __I._ Number of baths ---1- Lot size __________________________________ Water Supply: Public system [?F Community system ❑ Private ❑ Depth to Water Table 35_ ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan [❑ Previous Application Made: Yes ❑ yNo ® New Construction: Yes a No ❑ FHA/VA: Yes ❑ No [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . l " Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- Exiling No. of compartments--------------------------Size--------------------------------Liquid depth-------------=----------.Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of lines--i--------------------------------Length of each line...---------------------------Width of french------------------------------- Type of filter material------------------.------Depth of filter material-----------------------Total length----------------:_------------------------ . Seepage Pit: Distance to nearest well------nP----------Distance from foundation___.IQ---------Distance to nearest lot line__-___-5_4_____ h ___—5- __------------------ Cesspool: �$ umber of pits.... 1__,_______Lining material-----rgk------Size: Diameter-------33.--_._---_-Dept _ -- _4____._ Cess ool: Distance from nearest well_________________Distance from foundation--------------------- materYal_.__..,_________________________.___ SiLiquid -❑ ze: Diameter --De Depth--. Ca Capacity s ==°9 Privy: Distance from nearest well------------------------------------------------- from nearest building____._._____-__--._._._...--____-______- ❑ ante to nearest lot line------- ----------------------------�---------------------------------------------------------------------------------•------------------- Remodelin and/or ret g d� pairing (descnbe):________adds,-ng_--Filter_--Bea___to----existing-_-e-ye�em---------------------------------------- ---------- ---•_-__----------------- ---------• ---------------------------- ----- ------------------------------------------------------------------------------------------------------------•----------------------------•----------------------------- 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. D l:t& ep CTaTik- SerV6 : 1nC"------------------------- ---------------------------- - (Owner and/or Contractor) (Signed) By�-_------------ferry--- -------------------------- ---------------- ---------------------(Title}- 0erx._._Mgn'----------------------------------- (Plot plan, showing size,of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y: ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- = ----------------------------------------------------------------------- DATE-------------------------!-W-------------- ! -- 161-------------------- REVIEWEDBY------------------------------------� - ------------------------- DATE BUILDING PERMIT ISSUED---------------- --------------------------------------•-------------------------------------------- DATE------------------------------------------------------------- teratrons an or recammendations:'--_.-------------------------- .�.-Zy---------- ------1----- -------------------- -•- ------ ----- - --------------------------- ------- ------------------------ ---------------•---•-- I -•-•----•--------•---- ---------------------------------•-- ---------------------------------- ----- ----------------------------- --- ------------------------- -----------------------------------•------------------------------------------ --------- --------------------- FINAL INSPECTION BY:.------ -- : ' -- - ------P` Date_..._ d -�---/------------- --------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'591 P.Co. �-r