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W 411115 / � APPLICATION FO, J'ANITATION PERMIT Permit No. ....7-1----d_4 ' (Complete in Duplicate) Date Issued __�,/X/sz-_ Applica}ion 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-------------2-�2Q__.,��---hjQW�;--.-------------------------------- Owner's Name-----------------------E .ray.`T-Qn-e-f------------------------ ----------------------- ------------------------------------------- Phone----- Address.................. --- Address---------------•--••-----------....as e Contractor's Name. Rolla----•----------------------------------------- ----------- -- _----`----- ----------------------------•--- Phone........ Installation will serve: Residenceg] Apartment HouseCo E] E] ❑ E]mercial Trailer Court Motel Other Number of living units:l..---- Number of bedroom�Number of baths ___1_ Lot size ---7-5---x__ 75__________ •-----------•----------- Water Supply: Public system [jt Community system ❑ Private J] Depth to Water Table .- _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe® Hardpan ❑ , Previous Application Made: Yes ❑ No ® New Construction: Yes [I 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 well—110.-----Distance from foundation-----Ifl_---------Material---!Z IAPArit ------------------------------- 1:1 No. of compartments----------2-------------Size----{_�_X _�_X 1 ._._._Liquid depth__51.-&---3-1--------Capacity_$Q0_------------ t Disposal Field: Distance from nearest well....no_-___Distance from foundation-._�-4t---....Distance to nearest lot line._____5_1______ 1A1ANumber of lines-----_-1-------------------------Length of each ----- ---------------- ----_.Width of trench.----_--.------2 ----------- Type of filter material------rQCk-------Depth of filter materiaL___1.81,-..______-Total length___.-__.�0t________._ ____ 1 1 +Seepage Pit: Distance to nearest well.-----AP_-_.-------Distance from foundation____- __........Distance to nearest-lot line___12 S-____-__._ Number of pits-------- ------ -.-Lining material_bzCk------Size: Diameter-------3- -----------Depth_____z3 -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------- -_-._______._________--_-- ❑ Size: Diameter-------------------- -r--------------Depth------ ----------------------- --- ........ --------Liquid Capacity---------------------------- r,)� Privy: Distance from nearest well----------_-----------------------------------..-Distance from nearest building_______-_-_______________. - ❑ Distance to nearest lot line r A -41 8 8I; _ emadelin an or repairing.(describe)----------- ---,�� - -�-----�-m--------•-•,•-•-------------------••-------•---r--------••-------------------------•----------=-------------••- 7 / � i �,/ -- x - .� - - --- : --- .. : ------------------ - - � 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. r (Signed)---------Delta----------------------------------------- --- --• --- -••------------------------------------- --------(Owner and/or Contractor) By�•----------F_ex'-r ---Kar-than------- ---- - Title M P. - -- ------ - ------------------------------------------ ------ (Plot pian, showing size of lot, location of sys em in el to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------4 ------------------------------------------------------- DATE---- REVIEWED BY ----------------------------- ----------- --- -------- -------------------- ------------------------------------- DATE__.---------- ; BUILDING PERMIT ISSUED-------------------------------- ---I- DATE-------------4-----T Alterations and/or recommendations:---------------------- --•�-- --------------0'_...-- {r� •- ------•------------------- ----------------------------------------------------------------------------------- ------.-. -------------------------------------------------------- --------------------------- -----------------------------#---------------------------.------------------------------•-------------- FINAL INSPECTION BY------------ga'E-------•------------ ----- •----- Date----. . ---�- � -•--------------------------- -•--•---• 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 Ems'-`9-2m 145446 ATWOCD 12.54