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,FOR OFFICE USE- d -Y V <br />_r 1k <br /> ---- --------I N Ff5R IMITATION PERMIT. <br />------ #------------------------------------------------- APPLICATION Permit No. S.C........ <br /> Issued <br />--------------------------------- ----------------------- (Complete in Duplicate) <br /> L -"-L - I - -Date . ...... <br />---------------------------------------------—------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 2>0S A-6-9 ?64. <br /> JOB ADDRESS AND LOCATION--------------R O.U.t-6..I )3j2.X___j_9.26....Lqt_hru, Oq j il!t <br /> . <br /> Owner's Name----Benny.. i.m.-D...-Andaya------------------------------------------------------------------ PhoneHQ.jt....t37nZQ_ZAI...... <br /> Address_"__ ...nex-t----t-o----la-s-t...ho.us-e----o_n__..th.e---South-side <br /> S-ide <br /> Contractor's Name----.De Lt_C S-ep-t.1I.C..-Ta nA---Se rvi a e Inc --------------------------------------------- Phone... ........ <br /> Installation will serve: Residence 12 Apartment House E] Commercial [] Trailer Court [-] Motel F] Other E] <br /> Number of living units: ----L Number of bedrooms ---3_ Number of baths -1---- Lot size ---20--a,c-r.es................................. <br /> Water Supply: Public system El Community system El Private [M Depth to Water Table 5--"-_ ft. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam Q Clay Loam [] Clay C] Adobe L] Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No E] New Construction, Yes 2 No E] FHA/VA- Yes E] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sr,ptic Tank: Distance from nearest well-----------------Distance from foundation....................Material................................................. <br /> ExMstlng No. of compartments---------------------------Size---------------------------------Liquid depth---.----------------------Capacity......" ............_. <br /> Disposal Field: Distance from nearest well------------------Distance from foundation-.,,,,-----------------Distance to nearest lot line................. <br /> ,VxV t i ng Number of lines-----------------------------------Length of each line-------------------------------Width of trench.--------------.--------_--_------- V) <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length.................. ----------------------- <br /> Seepage Pit: Distance to nearest well----JU2�Rtp__Distance from foundation---2.(2F_t.,.._..Distance to nearest lot line--5-1 <br /> Number of pits--------Z------------Lining material---rack--------Size: Diameter-_-A.1------------Depth---4-1---------------- <br /> Cesspool: Distance from nearest wdll.----------------Distance from foundation--------------"--.-.Lining material..................................... <br /> El Size: Diameter---------------------------------------Pepth----------------------------------------------------Liquid Capacity..............----- gals. <br /> Privy: Distance from nearest well-----..-"-._.--. --_------------------------Distance from nearest building"_""".."""..............._._""_._..."""... <br /> 0 Distance to nearest lot line----------------------------------------------------------------------- <br /> \\\ <br /> Remodeling and/or repairing (describe):-------add.ing--- .4_0. <br /> �..exts t ing---------- <br /> ,.s.epti-c----tank.-ayatem------------------------------------------------------------------------------------------------------------------------- ------------------------- <br /> - ----------------------------1--------------------------------..............................................­--------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------I------------ ------------------------------------------------- -------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations-of the San Joaquin Local Health District. <br /> (Signed)-----•--- ---------_----- ------------------------------------------(Owner arid/or Contrac'tor)__�;:A,�_ <br /> By:.-------------�=Jy---0 AA.r.t h 9�?l-------------- ----------------------­---­----------------(rifle).....ae 7;A...g *1,1 "), <br /> ----------------- L..... .......... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,-etc., can be placed on-reverse side). <br /> FOR DEPARTMENT USE ONLY ► <br /> APPLICATION ACCEPTED BY------- ----------------------------------------_---------------------------------------- DATE-------// �. `--. .. .................-------- <br /> REVIEWEDBY---------------------------------------------- ----------------------------------------------------------------------------... DATE---------------------_-- <br /> BUILDING PERMIT ISSUED-----------------------------------------------------------------_---------------------- ---------- DATE------------------------------------ <br /> Alterations and/or recommendations------------------------------------"- -.................------------------------------------------------------- <br /> -------------------------------------x--------------------------------------------------- ........ ------------------------------------------------------------------------------------------------------------......I...... <br /> --------------­-­--------- -----------------------------------I------------------------------------------------------------------------------------------------- ..................................................... <br /> -----------------------•---•-----------------.....---- <br /> -------------------------------------------7......... --- -- -•- ------ ....... - -----------------------------------------------------------------------------I----------------------------I------------ <br /> ----------I------------------------ --------------- - ------ --------­------ - ----- --- ----- ------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPE16TIO <br /> Date....... C <br /> ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> Stockton,California Lodi,California Manteca,California <br /> CS 9 REVISED 8.59 2M 5-61 ATLAB <br />