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1 I APPLICATION FOR ..ANITATION PERMIT Permit No. ...�/., •L l„ (Complete in Dupl;cafe) Data issued .... 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. 544. JOB ADDRESS AND LOCATION .... ..M.7.... .. 0,_...9.P.. indn._:.d,...on...iesL....aide._of AZpine...RB..s....gk'ne R ` Owner's Name............. and Donna Johnson L. .i... X. l .. H `0fl2 .. ..... aa.. . �Address__... D .. . . .... ............ •... n .................._......................................._.................... ............ ontractor's Mame.............L'3,t& 3 7727Phone...HD._......� E: Installation will sen•3: Residence ® Apartment House ❑ Commercial El Trailer Court [3 Motel ❑ Other Number of livi-•g units: .-.... Number of bedrooms-..3.. Number of baths .2.... Lot size �20]C160 ❑ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ...4. {t. Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sand Loam Cie Loam Y ❑ Y ❑ Clay❑ Adobe® Hardpan ❑ Previous Applicafion Made: Yes No � _ ` ® ❑ New Construction: Yes E1 No ❑ FHA/VA: Yes ❑ No[X TYPE OF INSTA'f.LATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �= Septic Tank: Distance from nearest well 5.a Camant (round Distant from f Iaundation.,an7pl _M,� tet.. .--- ---- $xfQ( No. of compartments...... 2. .-........Size_ �.. ..... ........Z11Liqu;d depth..... gg,, . pty..._.. ........ Disposal Feld: Distance from nearest well....50�,..-D;sfance from foundation...amp1•tg---Distance to nearest lot line.,...01 •, �': -� [k Number of lines...........1....................Length of each line.......4.0.1............:..Width of trench........ �...................... T ' Type of filter material.----..rack... Depth of filter material.._...1��.........Total length..-.._1IS�.� ;. ........................ Seepage Pit: Distance .o nearest we!L...................•Disfance from foundation....................Distance to nearest lot line__......_........ xi @xing Number of pits......................Lining material.........I........ -.- Size: Diameter--_-------.........Depth ................... Cesspool: Distance from nearest :,elf..--:..........-.Disfance from foundat on... ........... Linin material....�.._.:.... g ❑ Size: Diameter........... ..:........................De #h............ p ............... ...............Liquid Capacity ................ ........gal.. Pavy: Distance from nearest wall........................ Distance from nearest building...............---, v . . ................. - Distance to nearest lot [in e.......................... • Remodeling and./or repairing (describej:._..8dd�-nQ.--�I1 BO.O--g8] ....cem.ent septic tank and 40 —ftr of s. . 3Q '�.�_Q>. .a2...Zs h...dra.�n_..t�_c. lsting system_anti ting-ln t.o ezistiri d rock- ULed..-eee .�g�...�iz ....:.... l .._.................................................................... ..........._......_........................".".."............................ .._...............•..._......•..---............................................................................................. I hareby eerfify that l Neve prepared this application and that the work will be done in accordance with San Joaquin CCU ordinances, Siete laws, and rules and regulations of the San Joaquin Lccal Health District. (signed)..........belta...43?. I.C...Tank _P.erviCB ...JnO* .....(Ownar and/or Contractor) BY: ..........P..Orz'Y._.tfRr h. ........................:........•....... ....... .. --....._...I——....--(rifle)........aener4...Menage.r.. (Plot plan showing size of lot, location of system in relation fe wells, buildings, efc., can be pin .._-....¢eo on reverse side). FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY...._c._,. . �h O,__............................................................ DATE----.... ..'i ��.J.. .....:....._........ REVIEWED BY... .............................. ........ .........................................__. . ... #, .. ...................... DATE_—......... BUILDING PERMIT ISSUED........... ...................... .........................._... DATE. ................ Alterations and/or recommendations:...... .............. .... .. ---------- L.-..- . ........Z.�.S�'.,..... .. ............ ...— S ............. :11l.. ........ FINAL INSPECTION BY:, ........ ...............-....... Date.................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amae;can Stra.f 300 Wast Oak 1Street 132 5 camors Stra1}� t y 814 NerFh "C"S+raa} Stocilen. CaMarnis Lodi, C.al;forn;a Man`•<e, Califerets Tracy, CaItfornia ES— —2M Ra�;sea 1.57 r.pCO.