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g . - — ,� r �6�APPLICA IT Permit No. ../,1.�...Y..5. lu Duplicate) / �`L � 011 (Complete in DP� ) Date Issued __/.��,.�/� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is i co1Jnpliance w. Ordinance F �nv_ JOB ADDRESS ASD �.ATION__ _ ____ X.,Q Owner's Name-- ------- - f%�1. `� -�'��% �-----==-- ---- ---------- --------------------------- Phone------------------------ Address------------ l --- --------------------------------------------------------------------------------------------------------•----- Contractor's Name--------------- ---------------------------------- ---------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - --- Number of bedrooms _ Number of baths/_g,.(. Lot size _ r----------------- ... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er_�`Hardpan ❑ Previous Application Made: Yes ❑ No Er New Construction: Yes [E No ❑, FHA/VA: Yes Zl-'-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well----- Distance from foundation__ C-_-. Mater�l---&.el: [ f No. of compartments__.. :_. ____. ._.Size__-j__ __ IY --------Capacity' Disposa�ld: Distance from nearest well.------------- r.__Distance-from foundation..__::--_-__.Distance to nearest lot line..,......... wll Number of lines-------- ----------------Leigth of each line----- ------_____.Width of french......A �` Type of filter materiai___! / PlDep}h of filter material----.j '`r__._Total length------,lam -------------------- Seepage _'___-_--_ _____-. See a e Pi : Distance to nearest well----------- ________Distance from foundation_.._ Distance to nearest lot line__: ___._ 19 Number of pits---._- -------Lining irtatenal+�__ :__e.W_ WSize: Diameter_,j? /f.____-Depth__. �'�t �_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth--_-•--: W••----------------------------------------•-Liquid Capacity------•---•-•--•--••----....gals. A Privy: Distance from nearest well--------------------------------------------.----Distance from nearest building-------.--------------------------..-_._-. ❑ Distance to nearest lot line - - - Remodeling and/or repairing describe :-------- 1, L'�r / " = �'� `_- ------------------------------- ------------------------ •-----------------•-_--------------------------------------•--...------••---------------------------------------------------------------------•-------------------•---------------------•--------- ---------------------------------------------------•-----------------------------------------------------------------•-------------------•----------------------------•• -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ Contractor) r� BY: �` f ._ - ---- ---------(Title)-- (Plot or or (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be-placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED --------------------------------------------------------------------------- DATE........ ----- REVIEWED BY-------------------------------------------- ---------_-- DATE--------- ........ 77------•---------------- -... ------------------------- BUILDING PERMIT ISSUED"--------------------------•------------------ - DATE Alterations and/or recommendations------------------------------------ --•--•--- •---- ------------------ --r ------ ------- •K•-------- ® - ------------------------------------------------------------------------------------ ---------------------------------1---------- -- ----- -------------------- ----- -- -------- --------------------------------- b FINAL INSPECTIO Y- - - ------ ------ Date-----LV- ^,� " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street' 814 North "C" Street S+nekton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.