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k -tit -M. <br />4 Permit <br />ANITATION PERMIT <br />No. <br />APPLICATION FOR 7 <br />,�� [Complete in Duplicate} Date Issued Y/_yt� <br />Applicalion Is hereby made to the San Joaquin Local Health District for a permit to constr& and 'install the work herein described. <br />This application is made in compliance with County Ordin nce No. 549. <br />oo <br />JOB ADDRESS AND LOCATI., P.� -le - ----- <br />- 41 ----­---- <br />271 — 2 e ------ ------- — -------- <br />Owner's Name--- -_----- --------- -- --- - --- <br />t A - <br />Address_----. - 7 -f ------ -11 ---------- --- - - -- ------ <br />Phone -------- --------- ---------- <br />Contractor's Name-_ --- - --­--------- --------- ----------- ------•-------------- . <br />Installation will serve: Residence Apartment House E] Commercial E] Trailer Court 0 Motel 0 Other 0 <br />�It K-15-000 --- <br />Number of living units: -_ L_ Number of bedrooms Number of baths __L__ Lot size -_ -------•----- -- ------------- <br />Water Supply: Public system 7 Community system 0 Frivate Depfn to Water Table /0- ft. <br />Character of soil to a depth of 3 feet: S I and F-l Gravel [I Sandy Loam [I Clay Loam El Clay 0 Adobex Hardpan <br />❑ <br />Previous Application Made: Yes ❑ No 71 New Construction: Yes [] No El <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic flank or cesspool permitted if public sewer is available within 200 feet.) -al <br />Sept' Tan I k istance from nearest well ---------------- Distance, from foundation.__. --------------- Mater - -------------------------------- --------------- <br />epLl.� I ­ .... --. Lliquid'clepth .... ; --_---------- ­ .... Capac;tY� --------------------- <br />0. 01 compartments-.-. ----- ---------------- size ----------- <br />from foundation -10 2j.,. <br />--- -_Distance to nearest lot line_ls . . .... <br />Disposal Field: Distance from nearest�well ...... /f'kP._ Distanceii <br />Number 01' lines-__ ...... /_.... Length of each line_-._--- - 406r --i ....... Width of trench ------ IIZAiA................. <br />9 — ------ -_ �J _1 <br />Type of filter material._Sj��__. Depth of filter material..J_e ...... ..----Total length,* ------ / -6- ------- ------------ <br />Seepage Pit: Distance to nearesf well_____________________ Distance from foundation ..... _ --------- ._Distance to nearest lot line_.__....._....... <br />❑ Number of pits ing material-... -- ------------- S-- ...... - Depth_ ...... _ -_----_--------- <br />------------------ Lin . __.Size: Diameter------ <br />Cesspool: Distar.ce from nearest well__._____-_-__._ Distance from foundation_.____________ ___.Lining material_____..___...._.....__......__...... <br />Size: Diameter -------------------------- . ...... _ Dept In .............. -------- ------ .................. .-.Liquid Ca ty.___.*__. <br />0. � - I - -_ ._P��I. . <br />Privy: Distance from nearest well ............... . ..................... ---------- Disiance from nearest building_ -:; <br />Distance to nearest lot line------_.._ ... ...... --------------------=-------•---•-------------------------- ------- <br />Remodel' 9 anjd,r �rierjing,.�(des rib --- ------- �__ ------ <br />-- --- -------- ------ <br />--- <br />7 ------------ ------- - <br />---------- <br />- --- - ------- <br />�Ce_, 'if -` <br />-.w ... et-'. <br />_W144A <br />p i. a in art&rdance with San Joaquin County <br />=- <br />I hereby certify that I have prepared this plication 4nd that the work will be done <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />•......... ...(Owner and/or Contractor) <br />jSigned) .... ............................ ---------- ------- ----------------- ­­ ................... I ........... ­ ----------------------- <br />----------(Title) -- ---------------------------- -------- --- ----------------- - <br />(Plot plan, showing size of lot, location of system in relation to buildings, etc., can 69 placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATIONACCEPTED BY ............................ ------ ---------------------- ----------------- • DATE_ ------.--.-_....------.--------•--------------- <br />REVIEWEDBY --------------------- ----------- ......... - ----------- ------------------_----- DATE-- •----.........-..--•--•--•-------•-----•-•---------------- <br />------- ------- *DATE --------- _ -------- - --------------------------------------- <br />BUILDING PERMIT ISSUED.. ......... ...... ............ .. <br />Alterations and/or recommends .ons- ......................... .......... ....... <br />e4& ..... .. - - ------------- <br />- - ------------ --- - - ------- -- - - - - --------- ........ <br />----------- I ....... - <br />­­- - ­---­----­---- - --- ------ - - ----- V <br />J. --------------------- -----------­- <br />- ------------_----- --- ------ <br />-- ------- ------------------------------------------------ ------ <br />P ------------------------------------- - -------------------------------------------------------------- •- ------------ * ----------------------- <br />­.. ------- .... tV ... <br />.. . ..... e;�', <br />r� S P li'l r Date--------------------- -_---------------- ----------------- ­ ------------ <br />FINAL 2 Tl N BY: ---- -------- --------------_----------- v -------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Sfroef 300 West Oak Street 132 Sycamore Street 814 Norih "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -9-2M . Revised W-2100 <br />