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t� 3v�fk /l APPLICATION FOR .NITATION PERMIT9,9&40 Permit No. .__�7_ ( (Complete in Duplicate) Date Issued ------ 11V Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County 0dna ce No. 549. �JOB ADDRESS AND ATION• -Owner s Name-------- ---- ----- ne- - - Address.... --�----- rtK-----f --------------------------------------------------- --•--- Contractor's Name------------ ........ -------- --------------------------------------------------------------------- •--------- Phone_... Installation will serve: Residence Apar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/--- Number of bedrooms __7--- Number of baths ---/-- Lot size -------- -----� Water Supply: Public system IV Community system ❑ Private ❑ Depth to Water Table _T/ ft. 7S-X /lo 7 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan Previous Application Made: Yes ❑ No VT New Construction: Yes No ❑ FHA/VA: Yes ❑ NoV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic T nk: Distance from nearest well_________________Distance from foundation----------------.__.Material-_-___.-_____-._-_-___-----___-____----.-.---_--. No. of compartments--------------------------Size_-------------------_.____Liquid de th--------------------------Caacit 4 Disposal Feld: Distance from nearest well-___-.-_.__._Distance from foundation---------------------Distance to nearest lot line---------_----- Number of lines___________________________________Length of each line------------------------------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material_--.____..__----_ _-__Total length------------------------------------------ 1 �/_ Seepage Pit: Distance to nearest well,-c__�-i -__Distance from undation�oi: _..Distan ce to nearest lot line- --_ i� Number of pits----/-__-_________Lining material . _____Size: Dia eter__..rr`l_. ___ ....Depth_-.-, 1�` ___•--- Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material -______-----_-__-__.----__.-____-:._.R` ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__--_-___-____-..-_-•.._-_-__-.-__._ ❑ Distance to nearest lot line--------------- --------------------------- ------------------------ ------ --------------------------------_---.-.-.-_-_-_-_-.-.-__ ---•------- n airing (describe): --- -- _ _____ - _ .----- ---------------- .-_ _ ------- ---------------------________________. _______..Remo ,Ee -__-__---___ -0. _.__ ............ -------------------•---------------•---•--------------------- . rl � --------------------------------------------------_____ _ _______________________••-___-__-_____.--__-__-_---_____-_--_-___-___________--__-____•--__-__..-_-_.____-_-._.---_-_-_--_-._----_---_-___-____-___- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a laws, a d ruled regulations of the San Joaquin Local Health District. (Signed)___-_____ - _____.__-low and/or Contrac+or) ------ BY=---------------------------------------- =-G�-�/--------------------------------------------------------------(Title)-- :��-�''-- - -----=--------------------- C Plot Ian, showing size of lot, Iota ion of system in relation to wells, buildings, etc., can b It aced o rev se side). ( P Y 9 P ) FOR DEPARTMWT USE ONLY APPLICATION ACCEPTED BY---------------------------------------------------------I---------------_------------------- DATE-------------- rtJ r--- _.----------------------- IBY------------------------------------------------------------------------------ 't DATE------ -- BUILDING PERMIT ISSUED ------------------ -------------- DATE - Alterations and/or recommendations:-___-_-------------------_-__--___. .._ _ }---------------------------------------------------------- -----------------------------------•--------- rr,. ------- ----- ------------------ --------------- -- ---a 4 -- --------------- -- ----------------------------------------------------- � - --- ----------------- -- - --------------------------- �s ..� #�'3- t --------------- ------------------•----••-------------•-------•------------•------------ 1!/t Al t,r)V T/ l,(, .6 U�/�i4C d.�dF .$'6<UJAV& SCP a..r°A1C C7 � � ��, FINAL INSPECTION B --- . - - ------- Date------ ,,. ---------- t S JOAQU LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Royisea 1.57 F.P.CO.