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� �. .3. � �R+F ter.• _- --,_"- - APPLICATION POR,ANITATiON PERMIT Permit No. _._7--�-tf ---_- (Complete in Duplicate) Date Issued Z_3I-S �' Applice-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ `d. This application is made in compliance with County Ordinance No. 549. , I JOB ADDRESS AND LOCATION�03�-.--KaA_� Q 4 !! ------------------•- ---------- Owner s Name. 4 5 D l -moo L L I + r -------------- ----- !� Phone----.`"�'--•------------ _ Address..41.3 ke-_wp.A. Contractor's Name------114. , �. _ 1a --- Phone- r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --(_---- Number of bedrooms _. A ,M Z-- Number of baths --�--_ Lot size -^ _ -- _(��_______ Wafer Supply [j _ Public system [" Community system Private ❑ Depth to Water Table f ft. s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe("✓]'Hardpan ❑ Previous Application Made: Yes ❑ No Ell' New Construction: Yes'[R"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wi#hin 200 feet.) Septic ank: !� Distance from nearest welf__�A(Q,.--_Distance from-f ndation_-10�.---------Materiai-_ .-_.--_ • ' --- - ---- No. of compartments..._�i- ---------------Size -�, - - tC `-Liquid depth,?-AA `.----_Ca -a -- P - Disposa Field: Distance from nearest well- --Q --Distance from foundatic --j©---_- .- Distance to.nearesf lot line- __- ----_ Number of lines------ --Length of each line_-=�59-'---_------•---_.Width of trench __2._ -~ Type of filter materieLl r4 - --,.,-Depth of filter material-. �7/."_ ----_ -..Total length-_ -_- Seepage Pit: Distance to nearest well .lr!_' -------Distance from fou dation__ I ._.Distance to nearest lot li i.-----__ Number of pits----------------------Lining mate ria i�-e- Size. Diam ter-_3t]_- ------------Depth-----?r------------------------ Cesspool: Distance from nearest well-___-- --_-.-`"Distance from foundation--------------------Lining material,-.__------_-__ QSize: Diameter-------------------------------------Depth----------------------- -- -- -----------------Liquid Capacity--- 9als.`T Privy: ,' Distance from nearest well ______________ Distance from nearest building 9 ------ ---------- �� Distance to nearest lot line---___ - -- ----- =---- -----------•-----•----- Remodeling and/qf repairin (dosc ----- ,ribe]: --- _ 'T., Q�p � 'Q � ef� - ----------- ------ --------- - ---- 11 ----- ordinances. State ---------------------------------------------------------••--------------=------------------•-------------------------------------•------•--------•---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County e laws, and rules and regulations of the San Joaquin Local Health Districf, (Signed)._ - Y T ------------------------- ------------------ ---- ----------------- ----------(Owner and/or Contractor) -- ------- -------- Title - ( ) ' (Plot plan, showingiz�cation of system inrelation to wells, buildings, etc., can be placed on everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...-------------------------- - ------------- --------•-------------•---------- DATE----------------- REVIEWED BY--M--_.._--_- - -- DATE----------------•---•---- Alterations and/orT ISSUED-----------------------------------atins --------------------•---------- --/- - -�- --------- ---------- ----------------- DATE---------------------------- BUILDING PERrata endations'___----- --------- --------------------•- 3 �Es6 - ---- - ---------------- 1 ------------- -------------------------------------- ----------•---- ----------• ------------ ----------- --------------- ---- ------------- ----------------------------------------------- --- I� S FINAL INSPECTION BY... -- - ---- ------ .......... Date--- f ---------- ! �� ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South Am wican Street 300 West Oak Street 132 Sycamore Street aro north "c" street Stockton, California Lodi, California Manteca, California 11 Tracy, California d ES-9—•2M iasaas q}w000 ,z-sa -- il