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�- v' }(T / APPLICATION FOR ,-.NITATION PERMIT Permit No. _ f_ (Complete in Duplicate) 31 - ., Date 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. 549. JOB ADDRESS AND LOCATIONJ----------------2nA...S�----9th y-----. --------------------------•- Owner's Name-----------•--Mr -and,.Xr-aa----- ra �� dW_��.�------------------•------ -------------------------------- Phone----HQ#----.74548_.._. 2728 E. Roosevelt, Contractor's Name---------Delt ------------------ Phone-HO.-,.3-77.??-_.- Installation will serve: Residence [?� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- --- Number of bedrooms -5--- Number of baths --i=---- Lot size --------5-0--_x_--1-----..-.._-------------------- Water Supply: Public' system ® Commuriity system ❑ Private ❑ Depth to Water Table _45 ft. Character of soil to a -depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No EIX New Construction: Yes ❑ Not].: FHA/VA: Yes ❑ No ER TYPE OF INSTALLATION AND SPECIFICATIONS: ^ (No septic Tank'or`cesspool permitted if public sewer is available within 2001'feet.) &. _ _ .f, . Septic Tank: Distance from nearest well-----------------Distance from foundation!___-_-_.-----.----.Material---------.-----------.------------------------ ExUting No. of compartments--------------------------Size--------------------------------LiJuid depth--------------------------Caacif Disposal Field: Distance from nearest well_________________Distance from foundation-''---------------- -Distance to nearest lot line-__-------------- ,. I EXUting Number of lines---.--,----_----------------------Length 'of each line-----------:------------------Width of french----------------------------------- Type of filfer material------ ------------- Depth of filter material----"---------- -------Total length--__---_-------_---__----,_.-------_--_-. I Seepage Pit: Distance to nearest well-- ELMP-I-e--Distance from foundation-----PXPl-e.Distance to nearest lot line----cl.IT1'Pj e Number of pit s.------I-----------Lining mdterial-----rock------Size: Diameter-------2V---------Depth-- 3Q-'--------------------- � Cesspool: Distance from nearest well-------7--------Distance from foundation''i-------------------Lining material------.------- _--_--------__----- ❑ Size: Diameter-j----- -------------- -;-Depth---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest burfding---------_----------------______--__-.-. ❑ Distance to nealrest lot line-----------------------------------------------------------'-- --------------------------------------------- { - Remodel� - � -ale _ ei _ Jt ' � ` �� . --- ---- -- -------------------------- { -------------------------------------•--------•-------..-..-------------------------------- ---------------------------------------------------------m--1-- -----------------------------------------------------------------------------i-------------------'------------------------------------------------------------ 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. (SiSi ned µ Delta Se-otic Tank Service, Inc. gned) ------------------ -- --- ----------------------------------------------------------------{Owner and/or Contractor) By:-----------------• ' We.rth�n------------------------------------------------------ ------(Title)-------Gen�---Ngre------------------------------- (Plot plan, showing size of lot, location of system in.relation fo wells, buildings, etc.,.can be placed on reverse side). FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY- ----- ------ ------ - -------------------- --- ---------------------------- -------- DATES - REVIEWEDBY--------------------------- --- ----------------------------------------------------------- -----='-------- DATE--�- BUILDING PERMIT ISSUED--------------- ------------------ ----------------------------_--------------------- ---------------- DATE------sem---------------------- Alterationsand/or recommendations---------=------ •------------------------------------------------- •--•--------------------------•-----••---....-------------•-------------•---•--------------- -------- --------------------------------------------------------- ---- -------- -- -----------------------t � '1� l ` -- -------------------------•-•--------------------------------- ----------------...._ . -- F -------------- - - �3 ---------------------------------5 - ---------------------------- FINAL INSPECTION � --•-- ---1---� --r------- Date------------ ----------------------------------------- SAN - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California - Manteca, California Tracy, California ES-9-2M Revised 1.57 FY.CO.