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FOR OFFICE SE ..... .... ..--• �� 1 bz �1 APPLICATION FOR TANIfATION PERMIT Permit No. ....I-. ----- _ -- ................. .... ..........•--•-••----------•-•-••• (Complete in Duplicate) Date Issued Issued .... ........ ..1 2-Z ......................................................... This Permit Expires 1 Year From Date Issued i2 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fhp work herein described. This application is made in compliance with County Ordinance No. 549. (-7 1- ( C;-Y 3 JOB ADDRESS AND LOCATION--- --CM_.. C �.... !i�.. .....s.....a.............................. Owner's Name----- ---- •- ............_............................................................................. PhoneH.47.5..21..:}. Address--•--.A-•&.•i-------S---- , - Contractor's Name..... -___. ............. Phone................................... ..'_�------------------ -- .......... Installation will serve: Residence 91 Apartment House ❑ Commercial ❑ Trailer Court ❑ g4b-Motel� Other ❑ Number of living units: -1..... Number of bedrooms ..,X--- Number of baths ...I... Lot size ..... O__ .......�... ,.�.. ..rl......... Water Supply: Public system Eo/ Community system ❑ Private ❑ Depth to Water Table 8.0. 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 a-IN. ❑ FHA/VA: Yes ❑ No 2--' 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___5.0...Distance frifm f undation_..__f_[?_........Material........... ..... .... ......... ...... tK No. of compartments-------Z►.............Size....S,/-_g'__-__`......Liquid depth........`f...�._________Capacity_._$_f�...0... Disposal Field: Distance from nearest well....S..�..-_Distanceom foundation ...1t2..�___.Distance to nearest lot�,e...___S__.r [� Number of lines________..._/....................Length of each line________-$__Q__-_-_..-.Width of trench a? Type of filter material__2__`Ak.�_Depth of filter material.j.5t--_'________Total length...... --------------........................... V) i Seepage Pit: Distance to nearest well......5-_(.-_-___Distance from foundation_____ to nearest lot line______ Number of pits..........i..........Lining material.......................Size: Diameter_..3.-,�__________-Depth.._.A. ................... 0111, Cesspool: Distance.from nearest well----!............Distance from foundation______..............Lining material..................................... h ❑ Size: Diameter..................... ------------Depth....................................................Liquid Capacity------•`_. ---------________gals. Privy: Distance from nearest well..............................................Distance from nearest building------------- 1 ❑ Distance to nearest lot line--------------------•_...---•-------=---•--"t------------------------...............------_.._....-----------_..._.......__...------------- Remodeling and/or repairing (describe).................................__-.........................................----------------------------------------( ---------....................•--------------.__...---.._._...--•--•--•-------------......---•-----•--•--..._._-•-----------•-•--......--••---••-•---•---...__..............................-_........................ . i 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San7JOaquin County 1 ordinances, laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- �---L4-----_->16--- __.�r• � ................................. (Owners r) gr-----------------•_......_...__._ .... ---- --- .....................................................(rile).......................................... ...._.....__...... (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). x FOR DEPARTMENT USE ONLY �+ lop APPLICATION ACCEPTED BY....I. ata----- . ..--•- L —---- DATE_._ S ,?, ----____--__ REVIEWEDBY................•--•-----•------•-------•----...--•--•-----•-----------------------•-••------------------._......_...•--_...._ DATE------ ----_- --.. ..................... "1 BUILDING PERMIT ISSUED v }}TTD T � - .- Altem __ � , & �x �C — ..t7-!r ` .. . . mac .--------- :�-_--- - Q --.. .. . . -----G--- ---- Lk�. ..... -------•--- ----- ---------------------------------------------------------------------------------•----.__.....------_----------- � ......................•--...__._........•----•---......_......_......------ ---•---••--•--------------------•-•--•-••-•--•-•------------------.._._._....----------------•-•-•••••....•-•••••-•--••--•------._:..•--------• ---------------------------------------------------------------------------------•-•--••-------..._..._----------....---......---------------------••-•---.........------------..._....-----...__.....-=--••••-•••• FINAL INSPECTION BY:----- --------------------------------- Date.. ................................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 705 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EA 9 REVISED 8.69 EM 15-61 ATLAS