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('� APPL.ICATION FOR �ANITAT)ON PERMIT Permit No.._..�-`_�__-_ } {Complete in Duplicate} ' Date Issued __�TI__-___... Applica-%n is herebyamade 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. }Sunse JOSADDRESS AND LOCATION -------- �--113--- ------------=---------------------------------------------•-----------------------...------•--------------- ------•---------------------- Owner's,.Name------------------------ 5choe!me - _,::. Phone_ n-0--------------------•••---- } ----- 1-ab9---1------AgaCA_&------ Contractor's Name ------------------------------------------------- Phone---------�:2�------- Delta 3— Installation will serve: Residence ® Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other Ely , � r Number! of living units: _1____ Number of bedrooms ____Z Number of baths -1___ Lot size _______SO_ x 100 ------------------------------ ,.A, _-.A, Watery.Supply : Public system [X Community system E3'Privafie ❑Depth to'Weter Table -------- ft.""~` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑l Hardpan ❑ Previous Application Made: Yes ❑ No ❑;• New Construction: Yes ® No ❑ I TYPE OFf1NSTALLATION AND SPECIFICATIONS: I i (No sepfic tank or cesspool permitted if public sewer is available within ,200 feet.) _ . a Septic, Tank: �) Distance from nearest well ---PP from foundation______-_.�_--__1Aaterial_____cCmtln i -- ® No. of compartments Size b---� ---�` Liquid depth �r-- —---- -------- Capacit.800 - -------------------- Disposal Field: IDistance from nearest well_________________ Distance from foundation -------------------- Distance to nearest lot line ----------------- e>usting_, Number of lines ---•------------------------------- Length of each line ------------------------------- Width of french--------- --_.__ { Type of filter material _----------------- Depth of filter material- _-_---.___-__------- Total length ------------------------------------------ Seepage.Pit: Distance to nearest well_-_rlQ----------- Distance from foundation___-_ __.-----.'-..Distance to nearest lot -_i ____--y . ® Number of.. _____ ___Lining material___�''� Ck----Size: Diameter________________-.____Depth___._-___--____-___fir_r .a -4- 1 - : Cesspool: Distance fi•om_nearest well -----------------Distance from foundation -------------------- Lining material ----------- �------------------------- . `� ❑ i. Size: Diameter-�- ` = : ---- Depth -----------------------------------------------#--- Liquid Capacity----------------------- `._gals. I 3 ---- -----------Distance from nearest building i Privy: ; Distance from nearest well____ ----------- ---.____-_-_ _ -v • £ ; :g --Y___ Distance to nearest lot line-.,--. - --nz- ." f ".�i ❑ - , �ti`-------------------------------- ------------------- :Remodeling and/or repairing (describel:-------- 0_ -....... CTS 1 Cr-- . .1?}cC---1 --- liO- be-_�LLFIIU C'�_i0-f_._water -- ---�f .�:"Q--- iso: =i h ---dirt ---- from --- n�j,,__S_e-----------nc-r_1v-�r�-.c-_l"'drain--��----��--b�-_Gdc�ed-- -----=--- -Wap r�l drP. rLEg.--• ----------------------------------•---------=---------------------------�----------------------------------------------------------- I'hereby certify''that I have prepared this application and that fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Sig . 3 De1:'t� = = -= - = = __ LOwner and/or Contractor) By----------------------••----------------"T------------------------------------- ------------------------------------------ Tifle (Plot plan, showing size of lot,. location of system in relation to wells, buildings, efc., can be placed on reverse side). : FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ----------- ------------------ ---------------------------------------------- DATES'---------------- --------------------------------- REVIEWED BY ---------------------------1DATE 4---------------•-- t--------------- ------------------ -- -- ----- --------------------------------------- BUILDING PERMIT ISSUED--- �- - --------------- DATE. -�,---------------------------------------------------- Alterations _-- ---- --'� --- - - -- - - -- - ------•-------- Alterations and/or recommendations_____________________________- w T_____________________________________---________-.--___------- .---_--_-_--.------------ ----------- ______________________________ ____.-__-_-_------------ -__________-__________�!---------------- .---------------------------------------- .----____-_-__________---_____-___--__________-______-________ -----------•----------------------------------------------------------------------------------------------------------------------------------------------------------------- y �.1 ---------------.-------•-- FINAL INSPECTION BY--- ----------------------- --------- Date. - �r __________________ SAN JOAQUIN LOCAL 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 W-2100