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APPLICATION FOR ANITATION PERMIT Permit No. ...7_7.2_?__ (Complete in Duplicate) 7 Date Issued pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. }pis application is made in compliance with County Ordinance�No. 549. JOB ADDRESS AND LOCATION---- ._------- ---- -----�--q- -----------('--------- --- JLAOwner's Name.__�hr'� W--------- ----------------- -------------------------------------------- Phone__ft�.- --!?_ Z' ---•-----•- . , � . 2 ate, ' Address----- 3 -- ------------------------•----------- -•--------------------• ---------------------------- -----------------------------••-------------------•------------ Contractor's Name. - Phone _ ! Installation will serve: Residence ®! Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A__-_ Number of bedrooms _1--- Number of baths ___l___ Lot size ._��Q�____`�__l S__U_-------------------------- �. Water Supply: Public system [KCommunity system ❑ Private ❑ Depth to`Water Table 4 'ft. Character of soil to a depth.of 3 feet: • Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ElAdobe [/Hardpan C1Previous Application Made: Yes ❑ No New Construction: Yes No ❑ i 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-----------._---_Distance from foundation___________________Material_________---_- __ _ __________ ______-____-_- No. of compartments--------------------------Size----------------------------=---Liquid d _epth--------------------------Capacity....--- --------------; � pp �., ilsDistance from nearest well- ________-_.Distance from foundation__.---__-______-__-Distance to nearest lot line_________________ Number of lines----------------- -----------------Length of each line-----------------------------.Width of french----------------------------------- -------Depth of filter material-----------------------Total length-------------------------_ ------ Type or' filter material______ _____-_-_ -- -•--- $ _ Seeps e Pit: ,Distance to nearest well_ _ A-44 -------Distance s from' foundation__ M_VLe,�_.Distagce to nearest lot li}�e_�-'x�_-_________ _Lining material__1k+3'c)/____.:_-Size: Diameter-___ �0-__________De th-----_?-�_-�1------------------- Number of pits------- ---------=- p Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Lining material_ _____________________________- I� ❑ Size: Diame#er.-f---------------------- --------Depth------------------- - ------------------------------Liquid Capacity-------_------------------gals. ry isbuildi ; "Privy:' Distance from nearest v✓ell--- - ---- --=--�--- -- --=------------.-- fance from nearest n 9------------------------------------------ ❑ -'Distance to nearest lot line--------------------- ----------------------------------------------------------------- ------------------------------------------------------- • Re odeling and/ r repairi g (d ribe):------- --- ------ - ------------------- k�-t��' ' - --- ----• ------�_ '4 --- ------ ---------------------------------•----------•------- ------------------- ----------- f _ ----- --------------------------------- ---------------------------- -----------•------- --------- - I hereby certify that l 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. E (Signed)_... _'�. --------------------------------------------------- -------• ------- -=- ----------------------------------------- --------------------(Owner and/or Contractor) { , By:---------- ----------------------- Title (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- DATE.., - � f� -----i---------- REVIEWED BY--------------------------------- ------------------------=-----------•:----------------- DATE -------------------- - ------- BUILDINGPERMIT ISSUED------- ----- ---- - ----------------------.--------------------- DATE--------------------------------------•--------------------- Alterations and/or recomrnendafions:_--- --- -- of - - - ----•------- ----- ----- --- --• ----------I' --_------- ------- - -- - - 7- 1� ---------------- ------------------------ ------------------------------ ------------------------------------------------------- - -, , ----.. k()d�`-, f f e e ff `-. - ------ ........ --------- - Date_. -- t;� = •--•--- FI:NAL� INSPECTION BY------------------'_-___ SAN JOAQUIN LOCAL HEALTH DISTRICT 70 130 Sotffh American Sfree_+ 30D West Oak Street 132 Sycemore Street 914 North "C" Street Stockton, California - Lodi, California Manteca, Californis Tracy, California ES--9-2M - Revised W-2100