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15 Z. C a x V (A: APPLICATION FOR ANIS ION PERMIT P� mi`t'No. .�J`'� - . . 5!✓ (Complete in Duplicate) =r� Date Issued --- S^Y 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 OCATION.I�/I 1�? _ /Q_Cs .I � -+7�------ICAP ----1-747-_ U.V 115-1-6 i L/ Owner's Name--------- --------II W-------------- -----------------------------._ Phone#.A7 _ O----------- --------------------- Address-----------------= � 1 _�... C� -------/&/-/ �91�,e . Contractor's Name,----!# `1° -1-------1031---R.-R4 ---- _ � ---------------------------- Phone_ ..�F___,(k-e--- ------ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel. ❑ Other [] Number of living units: .Number of bedrooms�>IA d Number of baths I___ Lot size -________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table6x`_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe($r Hardpan Previous Application Made: Yes ❑ No New Construction: 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 w r>�Distance from founclation_,�e�_/-____... .Material___ _____________ YLNo. of compartment -.---Wfe9--_------Siz �__� i_- },Liquid depthq.sf-___------Capacity_ ��f f,e Disposal Field: Distance from nearest well-/)14TetC-A1stance from foundation.-11210_1------Distance to nearest line__ 3_A Number of lines____ Length of each line____ L _� Width of trench_____ _4------------------ K !______________ Type of filter material -D-Depth of fil mate ' I___.______ __ Total length___ e ---------------- Seep Pit: Distance to nearest well-20 fTYDisfan orrR o at n____:___! ___.__.Distanifto nearest lot line:. _.___.. Number of pits_ ___Lining mat ial__ e: Diameter- ___:___.Depth__;,4•_,,e�"_"________________ Cesspool: Distance from nearest well-__________-____ istance from-fou anon--------------------Lining material' .___-------------------------------- ❑ Size: Diameter-------------------------- --- - ePth-------------f -------------------- ------ - ---Liquid Capacity-----------•--•-------------gals. Privy: Distance from nearest well-----------_------___________--------------------Distance from nearest building-------.--------------------------_____-_. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------•----------------------------------------------- Remodeling and/or repairing (describe): ------------ ----•------ ------- -- - --------- --------------•---•---••-----------------------•----------•---- -----=- � �l af -------- ------------------- •--------•------------------------------------- .....------ ------------ ----------------- ------------------------------•------------------------------ -------------- ------------------------------ -------------------------------------------- I here certify that I have prepared alis pplica+ion and that +he work will be done in accordance with San Joaquin County ordinances, fat laws, and ales and r ulati ns of +he San Joaquin al Ith District. Si ned (c9,,. } -------- --- , -------- ---- -- _.I . ------. = .. Owner and 'Contractor B ` ------------------- -----{ /cad Y• �C'1, t,: Title ------ ---. . r (Plot plan, showing size of lot, location of system in rl ation to wells, buildings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY \ APPLICATION ACCEPTED BY- = DATE-- `Ej��_ REVIEWEDBY------------------------------------------ ------------------------------------------------------=t .------------ DATE--- --- --- ------ BUILD€NG PERMIT ISSUED------------------------------------------------------------------------------ ----------------------- DATE Alterations and/or recommendations-------------- ------------- ---------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------.----------------------------------------------- --------------------------=---------------------------------------------------------------------------------------------------------- ------------------------------------ -------------- - - - ------------------------------------------------------ ----------------------------------------------- FINAL INSPECTION BY:• = �'' '^ � Date _Y _----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I f30 South American Street 300 West Oak Street 132 Sycamore Street SM North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100