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FFICE USE: .-Pernnif No. 3 ----------------- ........ ---- ------ ��1 APPLICATION. FOR !S�X141f-ATION PERMIT -------------- -------------------- ------------- --------------- ------- (Complete in Duplicate) )& Date Issued ---- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local He-aI+h District for a permit to construct and 'install the work herein described. This application is mae in compliance with County Ordinance No. 549. - ----------------------------------------------------- JOB ADDRESS AND LOCATION---"-- --- --- --- ----------- --------------------- Owner's Name---- -------- - - -- - - - -----••----.:..-•-------•----•---------------- -------------------------------------------------:.... Phone------------------------------------- Address_.... --- ---------- ---- ----------- ------ ---------------------------------------------------------------------------------------------------------------------------------- Phone------------ ---------- Contractor's Name. - ------------------------------------------- ------- - ------ --- ❑ Motel [3 Othe Installation will serve- Residence [I 'Apartment House [I Commercial [] Trailer Court Number of living units: Number of bedrooms - Number of baths _�—_ Lot size ----------------------------- Water Supply: Public system El Community.system gr Private epth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam El Clay Loam El Clay 0 Adobe 9-<Ordpan C] -No Previous Application Made: (if yes,date.__________________) No New Construction: Yes RR-'T�o El FHA/VA: YesZ�- 171 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank-or cesspool permitted if public sewer is available within 200 feet.) 7" ' 10, --------mate'rial- Septic Tank: Distance from nearest weillz_e�_ ---Distance from f6undafion--z &- -. --- ------ ------?490 -Sizaa I.V iquicl depth__I�st" Capacityl-I ------------- No. of compartments-_11, _�j - _1� - --:r---------------- --------------------- Disposal Field: Distance from nearesfwell--- I.Distance from foundation___-.2�_l------Distance to nearest lot line._.____.-.__ 4_ X, Number of Length of each line__.- ----------------Width of trench.----__---------------------- -,Type of filter.material Depth of filter mat eria L- ----Total length-_;" 4"-- ---------------------- jr i 0 r Seepage Pit: Distance to nearest well__,,1"Xe0'_/7Distance from f'undat*ion-- -'.----.Disfance to nearest lot line______`______--. V ,Z.-'----------Lining Number of pits_--- material__AW z__.Size: Diameter D e ptka.,-_ o -, l"KI, f 4601� Cesspool: Distance from nearest well------------- ..-_Distar�ce from foundation-_-_._._ '_.----Lining material----------------------------_ ------- tP VY Size: Diam;fer--------I------------------------------Depth------------------------------------------t----------Liquid Capacity----------------- ---------gals. El ' ' / F 2 '.nearest building----.------------------------------------- Distance uildin - Privy: Distance.from nearest-well--------------------------------------- ---------Distance from 9----------------------------------------- 0 D;stanc e to nearest lot line---------------Y--------------------------------- -------------- ------------------------------------------------ ------------------ --------- Rem�deling and or repairing --------------------------------------I-------------- ---------- jr ----------------------------- ------------------------ -----------------------------------------•------------------------------- ---------------------------7---------- ------------------------------------------------------------------- ------------I---------------- --------------------------:-------*------------------------------- -------------------------------I-------------------------------------------------------------------------- 0 ---------- ----------------------- --- -----------------I--------------------------------------------------------------------- -------------------------------------------------------------------------------- I hereby certify that I have prepaied this application and that the work will be done.in accordance with San Joaquin County ordinances, State l;a;ws, and ules and.regulations of the San Joaquin Local Health District. --------------------------------------------(G*nm=i*=d7%r Contractor],A --------------(Tifle)--,,;g -4----------------- ------------- (Signed).------- By:---------------•----=•---------- ------------------ -------------- -- reverse side). ' ,�[Plot plan, showing size,of lot, liocati6n Lof system i afionjo wells, buildings, efc.,.can be placed on rev FOR DEPARTMENT USE ONLY DATE------.............. ---------------------------------- - - APPLICATION ACCEPTED BY ------ I . I ------- ---------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY--- ----------=--------------------------------------- -----------------------------------------I------------------------- ifII , TE. ----------------------------- BUILDING PERM 1�1,'-ISSLI ED-----1. -------------------- DATE._- -- ----------- ----------- --------------- _z� -------------�_ _ ------- Alterations and/or recornmendifi, ........ ----------------- ---------- ------ -------- - - ------- ----------- - -- ------------------------------------ --- -------- -- -- - ------ ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- ------------- ---------------------- ----------------------------------------- --------------------------- --------------------------------------------------------- - ------- -------- --------- FINAL INSPECTION BY:, --------------------- ----------- Date-- A ------------- --------------------- _( SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California k Manteca,California Tracy,California 9 REVISED B-59 3M 3`63 "--Ca-