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APPLICATION FOR,5ANLT-,ATION PERMIT Permit No. .. 51-a ��. (Complete in Duplicate) Date Issued Applica+ion is hereby made'Mto the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in lompliance wwith County Ordinance No 549. JOB ADDRESS AND L CATION.- ,; 3 ------ -- ---- ------------- �-----------------------•-------------------------- ' ' � � Phone--•----•---•-------------•--------.. Owners Name------------- ------------ ----- -- ------- - Address------------------- --•--------- --------------------------------------------------------------------- Contractor s Name---- ----• E=7 ---------------�--------------------- - - - - Phone .. l Installation will serve: Resi I ence [Ef'�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unifs: _�__._ Number of bedrooms // i _. Number of baths l---- Lot size ---------S--d-------x--1-2-e------------- r Water Supply: Public system ❑ Community system ❑ Private 2'Depth to Water Table �s_- ft., n I Character of soil to a depth; of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[]�Hardpan ❑ l Previous Application Made:; Yes ❑ No M-` New Construction'. Ye?No R-- TYPE OF INSTALLATION J" SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Tank: NoDistance n e from nearest well_________________Distance from foundation--------------------Material____________._____._____.___.._..__-____________- r Ifcompartments-------- ------Size----------------•-------- ------Liquid depth--------------------------Capacity-----------•----------- i oral field: Distance from nearest well_________________Distance from foundation__-__-_-______..___.Distance to nearest lot line.___.__________.- +yr Yp r of lines-'-----:-------------- ----- Length of each line------------------------- Width of trench T u ebof'filter material-_- _____-_____Depth of filter material_____________________Total length------------------------------------ J� .- _ .. A. i �. Seepage Pit: Distance to nearest /w/ell_.Jf~Q-_ _-_--Distance from foundation___f�d__ _.__Distan5e to nearest lot lme____`5_________ Number of pits.__---1- Lining material_S�_ _-- .----4-Size: Diameter---- -_--------- Depth-------t ------•--------- p� :If Cesspool: Distance from nearest well________________Distance from'foundation--------------i-_,_.Lining material__.________.___________-_---.---_____. ❑ Size: Diameter------------ ---------------------Depth------------=---------------------------------------Liquid Capacity----------------------------gals. q I�' ' ._Distance from nearest building Privy: Distance from Tom nearest well:.-�-- -------=------- ----------- ---- -- 9----------------------------- ----------- ❑ i — Dis#once to nearestilot line ^_________ ___ _":__'°_ _-_--__ ---- f �� l ,. F.- ,..wrra..• � - • 1 Remodeling and/or repairing (describe):--------''---:-"----------' - �------ ----------- ...........• -------•----- RI ---------------------------•-----------------------------------------------••-•------------------------------ 91 ----------- -------------------------------------------------------------------------------------- -••-••-------------------------•---------------------------•-------------------------------•----•-------------------------- 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. -A� -------- ------------------------------- ------------------ -- --(Own - and/or Contractor) F/? Title --- ------ -------` - By: showing size of-'-- - - (Title)- (Plot plan, sh g allot, �Iocafliof system in relation tc�wells,:buildings, etc., can be paced on reverse side). �i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :i---- DATE - -------------------•-------- ---------------------------------- REVIEWEDBY------------------ ------ � `--- ------ ------------------------------------- --------- DATE-- . BUILDING PERMIT,ISSUED.- = -- ----------- DATE-------- -- -----------P -.i, �� + Altei:ations+zand/ar recommendations - ------ - -- -------- ------ ---------------"------------ -e=-••-------------------------------------- - ------------ --------------- -------------------- --•------- "I_t•f sl�� +:c!�'Y"p1 ±.rl •_ __ r�!- ._ -�<-�=` ��.- + + , it - -------------- - - --------••----- ------ - - ....... .. - *� -- ---- --- -- - - "----------------------------- ------ -- - -- -- - _ ------- --- --- ----------------- c__ --------- -- - FI�A�L ENSPECTION BY:------ : y. Date---- - ----- .� -------------------------------------- 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 W-2100 II