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�� t APPLICATION FOR _A _ _ � NITATION PERMIT Permit No. ._-`7.-,S � r< (Complefe in Duplicate) ..................... Date Issued .__. /1-!1'S Applica-ion is hereby made to the, San Joaquin Locaf Health District for a permit to construct and install the work herein described This aP1plicafion is.mada in compliance_with,County Ordinance No-549. j # r ea r q—V-0_3 JOB ADDRES�D�OC�1•TION' "` : • , �- -- a--- xr_�62-�-- .-.-Fremont---�O. BeCc-_'_.e Owner's Name__: box 662 on the left Side of road �------urn rt, to =----D,0b&j_e----------•---•--•--------- -- Rt II Box 662 Btk1 Address Phone-_ L----5-Qa7.`9.--- Contractor's Name_. ----------------- ------------------ -- ----- -- -----D---e---1--t o f -- --------- -- Installatian'will serve: Residence ] Apartment -ouse ❑ Phone__H�'---3--1268 Commercial ❑ Trailer. Court Number of living units: __ -- Number of bedrooms ___2-- Number of baths --- ❑ Motel ❑ Other E Water Supply:" Public s stem : Lot size ___x-50 x 200 Y ❑ Communit s stem 3 Y Y ❑ Private 91 Depth to Water Table •O--- ft. Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay ❑ Adobe Previous Application Made: Yes ❑ No [?�1 New Construction: Hardpan [� Yes �] No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) l eiSeptic Tank: Distance from nearest well-_.__...__-_.___Distance,{rom foundation---------------- isUng-_, No. of compartments---_- --- .._.Material----------------------------- _.:_...Size-------==---------- -----------Liquid depth-------- Ca ecFtY --•-- ----- Disposal Field:-, Distance from nearest well------------- --Distance from foundation___`-__...__-.____.Distance to nearest lot line________._____.__ axis n -� '► g Number o{'lines-------------------------- --------Length of each fine------------------ � < Type(6f filter,material-__--- ---- ------.Width. of trench--------------- __ _. ------------- --------.-Depth of filter material-----------------------Total length- -----/0A--�� Seepage Pit: Distance'to-nearest well____.-- aQ-__ ----------------- i r P t ___Distance from foundation_ Q.------.Distance to nearest lot line -51-- NUmber of ifs.__--------- ------Lining material--brj;k__-_.Size: Diameter._____--3 Cess ooL I ----------DepA_------t9 ", �,,� ` P Distance from nearest well____.___.___. - Distance from foundation___- --_-- Lining material___----- ❑ Size: Diameter--- Depth x f ------------------ ------- --- -----Liquid Capacity-----------------•---- --- PnvY: Distance from nearest wegals. -------------------------------Distance from nearest building t ❑ - Distance to nearest-loft line-..__�--_-�--- g--�-- -------------•-----.----_---------" -------------------------------------------------- ------------------------------ Remodeling and/or repairing (describe):---- - ---- - � -- -- .�I'lg--fie-e I F fit----to--.ex�.s11-ag Y_ el --- --------------------- f IN ---------- ------------------------ -------- ------#----- hereb certif that I have re areg this a lication and that ------ ----- ordinances, State laws, and rules and regulations of the San Joaquin Local HealtheDistric}� accordance with San Joaquin Coun#y (Signed)_! I * Delta � t � -----.---- --------------------(Owner and/or Contractor) BY� ° ---------•P. Q-.----W- -(Title)- ------------------=_Mgx'' Plot plan, showing size of lot`iocat'On of system in relation to wells, buildings, etc„ can be placed on reverse side). F ---------------- a FOR DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY_____------- ------ •-------------------- DATE------ ; REVIEWED BY ------------'--------- --- --- •-- -- BUILDiNG PERMIT ISSUED---`----�`.} )1*f ------------------------------------ y .^"•I �-:' ` ---- DATE - --- _ - ------------•---------------------- ------ DATE_.-----•---------- terations and/or recommendations:._,_ --------" -" ------------------------------------------ ---------- _ __._ -- -------- --- - ------ ---- _ _.._ ----- ------------------------------- ------- --- � ' C - - _. --------- - -- •--------- Ii~_71w... _ t ! ................ . .... __ ____________Dat___._____. FINAL INSPECTION BY:..___-___ ( ---- J e----- ----------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stree+ Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWppD 12-54 k