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-L4 .OR OFFICE USE: W --------------- ' r --------------------------------- ----------- ----------- APPLICATION FOIL' SAI`•tTATION PERMIT Permit o. _...��7 ----------------------------------- ------ ---- ------- (Complefe in Duplicate] _ Date Issued .,;y---tea D'G ---..__..........................._.-_.._______._____._-_ This Permit Expires 1 Year From Date Issued Application is-hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 'LOCATION =-48Q1_-Freffi®_nt------$t_a_Ok on------------------------------------ ----=-------------------------------------•------------ Owner s Name---------Ray-Xl_12inger._Cons_truction--C-Q-.---•-•----- ------------------------------------- Phone-- --------------------------------- Address---------- :5948 -s-tan-l-- eg Aver CF,ts'm -Chael�.._Cali.f.--------------------------------- Contractor's Name------CAI-ESTBR---84il- 'AT`ICN--- 0_i___�_.C},:B�x---4242-r---S�>� �Phone__485.B47-1,--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [j Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ----------------------------------_...____._._____-_-_________ Water Supply: Public system ❑ Community system ❑ PrivateKj Depth to Water Table ________ ft. Character of soil to a depth of 3 fee+: Sand E]-Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ .Hardpan ❑ Previous Application Made: Ilf yes,date____________________} No IN New Construction: Yes:U No ❑ FHA/VA: Yes ❑ No 52 TYPE OF INSTALLATION,AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _- �- Septic Tank: Distance from nearest I well___-lO-O--- --Distance 8foundation--115- ------:Material------ _0ncret-e-------------------- _1_10 ---------Capacity-------15-OO-----No..of compartments ielq . 4 Disposal Field: Distance from nearest well-_--Y Q._._.Distance from found�ti n ---3-2_i -------Distance to nearest lot line-_______________ ® Number of lines__________Z____________________Length of each line_ Z `67_._.Width of french-------3....................... Type of flter�material___�,&J RezFkpth of filter material--------------1$!kTotal length----------- t Seepage Pit: _ .Distance to nearest well______��Q___-_ _Distance from foundation--------------------Distance to nearest lot line----------------- 12, _____________._1 , Number of pits.. 2 ----Lining material____C.®.bb-le Size: Diameter-------42-1-#---N---Depth_:__.-____ _25-�__.______-- om Q Cesspool: Distance frnearest well____ ___________Distance from foundation_==:/___ __.Lining material__-.____-----_p�________-__-_. { ❑ Size: Diameter--------------------------------------Depth-----------------------------------=----------------_Liquid Capacity gals. Privy: Distance from nearest well----------------:---------.------------------`___Distance from nearest building----- _______________.___.._- �k a Distance to nearest )of line - ------------------------------j------------------------------- ------------------------------- ----- ---- _ ------------------- - Remodeling ana/or repairing (describe):-------------------------- ----------------------------------------------:----------------------I-----I------------------------=-----•------------------ ------------•------•--------------------------------------------------•-------------- --------- ------------------------------------------------ ,----- ----- -----------------1---------------------------------------------------------------------------------- 4 I hereby certify that I have prepaied this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- C _- r6 _ _� C]_.>�_�Cil. s -4�rir �Yl�. ------------}-----=---------------------------------------------(Owner and/or Contractor) 4 By=--- J- 7�- =-',1.t` ---------------------=----------------------------- -----------------------(Title)------Pre_s idem --......... �. (Piot plan, showing-size of lot, locatio005 system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY----------All, --- -----r--'Y"��— ------- -------------- C- ------ DATE-------- � -�--�--- - REVIEWEDBY------------------------------------ ----- --- ---- ----- ,----- ------------- --- ----------- DATE BUILDINGPERMIT ISSUED-------------------------=-------------------------=---- --------------------------------------- DATE.--------------------------- ---------------------------,-- Alterationsand/or recommendations------- -------------------------------- ----------------•---------------------------------------------•------------------------------------------------------ ------------------------------------- -------------------------------- --------------------------------------------------------:-------------------------- --------------------•----------------------------- -------- -------------------------------------------------------------- -------------------------------------------- FINAL INSPECTION BY:_._._.........`......_------C_`--'•--.---------.------- Date-------------------------------- -- -- --- ------ -- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300.West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD. - - 1