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FOR OFFICE USE: Permit No. "-�-- y� ------��'-`�- - --- ----- - -- APPLICATION FOR SAN4T�+TION FERMI " "-- - ----- ----- -------- -------- -----f "" (Comple}e in Duplica}ei Date Issued - 1.3 - _.- `---- "" This permit Ex fres 1 Year From Date Issued d. --- --- ----------- r - to the San Joaquin Local Health Distric 549 a permit #o construct and insi'all the wor 'herein„ escn e Application is hereby made This application is made in compliance with County Ordi ante No. G = -------• ---------•--------------------------•--------- h ------------- ---------------------- LOCATION ,SOB ADDRESS AND ___ _ P one Owner's Name_.,K1------ --------------------- - ---------------- } ------- Phone .-----•-----._.._ �1�� qui - ------ .� Wit" 11 r-- - ---- Ad ss - ---- ---- - S O#her ❑ --- •----------------------------------- •- Motel ❑ Contractor's Name----b- Trailer Court ❑ artment House ❑ Commercia4 ❑ Installation will.serve: Residence p Number of baths ---/--- Lot size. /------ t Number of living units: ___!___ Number of bedrooms _- - Private [B'DePth to Water Table ft. ardpan`❑ Community system ❑ ❑ Adobe Water Supply: Public system ❑ Sand Loam Clay Loam ❑ Clay ❑ F No�-� Gravel ❑ Y �,�,�❑ fHA/VA: Yes ❑ Character of soil }o a depth of 3 feet: Sand ❑ New Construction-. Yes [! ' "' -- -1 No Previous Application Made., Ilf yes,date-------------- i TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep}ic tank.or cesspool permitted if pub licrse "s#anwer is ceafrobmefoun�daZoo"f �.- material----- -- • l Distance from nearest well--di Y � Capact#y--.�.---•- ---------- Sept'c'T nk: ""Size_._3"`x 5---- -�.---•---Liguid ept ----- ----------------- No. of compartments_-�---------- ---- y �` ir--- nce ot Disposal .field: Distance fro st well.-47P1- ---Distance from foundation".�� Width ofttrenchest Ing- Number of lines--=�----- --- Length of each line-_ .cS-- ; �o#a1, length:---- wz--' , 1 �_ n _ M -� Type of filter materiai_'�-��=- -------Depth of,filter material_$'---�------ - Distance from foundation-"_�9"------------Distance t�Dea+es# Ise_j-- ---~ Seepage it: ' Distance to nearest weil`'d0-- Size:,Diameter_ { ��' P Linin rnaterial77- '- ---- Number of pits------- ---=--- g r ------------------------------------- wellgals r Distance from;nearest ______________Distance.from foundation-__._..__"_-___.__-Lining material Cesspool: '• Depth = -.Liquid Capacity - i - - - -- Size: Diameter"- --------------------------------, _ .p} t_: ._.: :3r: ,-.. -._.. .. � --------•-------- -_• _"- -"-.-Distance from nearest building._ ---�� .' r-. _ - -------------------- Privy: ------------------------------ ... Distance from nearest well •� 1] Distance to nearest lot line---------------------- t f = Remodeling and/or repairing (describe):-- - = ----•--'-----:---- - t ---------; S -•------ ---------- ----------------- S ------------------•------•- ------------------------------------------ -------------- --------- ------- -• -----------------------------------------•----------- ----------------------------------- - t I hereby certify that ! have prepared this application and that the work;' ork will be done iti accordance with San Joaquin County I ordinances, State Laws; an r s and regulations of the San Joaquin Local Health District. ' I Y.t S 7�. ----------------------------------------(Owner and/or ract d/o Cont or) l (Signed) ------ ------- - ---•--- -- e]" --- -- ----- -- -------------- ` 'By:------------ ------- ------ -------------- - (Flo# plan, showing size- of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side(. ' FOR DEPARTMENT USE ONLY r k i 4DATE------- r - ' `` "' �"- `' - APPLICATION ACCEPTED BY_____________ -------- DATE- I REVIEWED BY---------------------------------------:----- --------------------- ---------------------------------: - !•, ` .-.'. `tel �.ce�"-:r�)----} ^T �----�-- --- � " BUILDING PERMIT ISSUED----------------:----------- -------°-- --- -•----- ------------------.------------ .�. Alterations and/or recommendations:_-.___..__, ��'-.- ` - - s -------------------------------- �- --<e - /. --------------------------------------- --- -------- I ------------------" `` I -------------------------------It-.--- l ------------ -------------- ------ ----------- s -- F K ------------- ? l Date- ---- ----- --- FINAL INSPEIZ BY:._--. ----------- -- S N JOAQUIN'LOCAL HEALTH DISTRICT 3Q West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.Hazelton Ave. Lodi,California Manteca,California Tracy,California .Stockton,California ES 9 REVISED 9-59 31A 3-'63 F.P.CC. �• .fig ... ._.