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NITATION HERMIT Permit No. __�/J_.7.. APPLICATION FOR SA V ' t li D (Complete in Duplicate) Date Issued YW�/._ pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. (7is application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION. 2141 E. �'�h S�. 1 --------------------------------------------------------- "t Renter -- J...... ----- ROCk------- Phone__A9.t-------------------------- Owner s Name---M0ry___ZM1T&A im------------------------ -------------- Address--------------- la... D:X__ 7 .LOd .....E`'-allfA-------------------------------------------------------------------•------- Contractors Name------D_81_tEL#---=in8-11------------------------------------------------------------------------------------------------------- Phone__Ii.Q.....3-7-7-2-`r---- Installation will serve: Residence 91 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: 1_____ Number of bedrooms ---3.- Number of baths I----- Lot size ---1Z5--x---73__."------------------------------ L. Water Supply: Public•system K],,,Community.system,❑.Private ElDepth to Water Table __4- ft. Character of soiltoa depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ElClay Loam ❑ Clay El Adobe [Z Hardpan E] Previous Application Made: Yes ❑ No I� New Construction: Yes :K] 'No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) • . ' I 1 Septic Tank: Distance frorn nearest well_________________Distance from foundation______-_-________-_.Material---_-____--"-----___-.-________._-____-_---_---. EXi eULng No. of compartments------- ----:- ------Size-----•-•----- ----------- -- ---Liquid depth------------ ------- ----Capacity---------------- -- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line___----_________- t FX3.8VLn9 Number of lines-------------------------------- --Length of each line----------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter mat erial-----------------------Total length------_-"-------------------------------- Seepage ----------------- Seepage Pit: Distance to nearest well----!IQ------------Distance-from foundation__81AP1-9__.Distance to nearest k4"a ---------------- e----PPIP Number of pits:._.1._____._.______Lining materiaL__x'OCk___-- -_-Size: Diameter___-28 ----------Depth_ -- -.-��_- ess ool: Distance from hearest well---------------._Distance from foundation --__-__-_-___ ".Lining material------------------------------------- .❑ Siia: Diameter_' ----------Depth--------------------------------- --------- --------Liquid Capacity-- -------------------- ----gals. Priv i Distance from nearest well--------------------- _____-_Distance from nearesr building__.______.-_._____-_______________ ❑ I Distance to nearest lot line------------------------------------- tin - Remodeling and/or repairing (describe):----------&C1.S��Ag---$e_ep_8�i-e---PZ�---�a--eLB- ----- et em----------- -------- ------------------ ---- --------------------------------•-------•---4 -. •- ------•----•-------1------------ ---•--------------------------------------- n --------•-------- -------------- --------------------------------------------•------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. Signed _ f Delta,---- nc-+---------------------- --------------- ---------------- --------------- ----------------- ------ (Owner and/or Contractor) By:---------------- --------------------------------------- -$PI'�j-_Wa?tI' Sri (Title]-------Aln. -lgr------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). : FOR DEPARTMENT USE ONLY 3 57------------------------- APPLICATION ACCEPTED BY----- ---------'------ ------ ----------- ------ 1------------- DATE ' )----------------------------------•--------------- DATE------------- -`--�--------------------_------------ REVIEWED BY__*'".`_,.�"..--------------�----------- - ------ - BUILDING PERMIT ISSUED_. ] DATE._ f ------------------------------ ---- -------- ------------------------------------ Alterations and/or recommendations:---------- --------- --- E j -------------------------=--- ----------- - --------- := ---------------- -------------------------------------------------------- -- -- l � FINAL INSPECTION BY:- ar': Date-- �SAN JOAQUIN LOC 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 ES-9-2M Io-52 Revised W-2100