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APPLICATION FOR a, NITATION PERMIT SC Permit No. ... �� 1 I 0 (Complete in Duplicate) y� / I This Permit Expires 1 Year From Date Issued--- L-�C.-�PZ 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 made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__._ _-_100] South Burkett-_.-_-_ / Owner's Name-----...----Richard And Mer ---R -----------------------'------'---------------•-•----------'----------------- Address '-----------------1Q Contractor's Name .Q1 S-Q.- F311?ketL -' - -- -- -- -- -- Phona_Ho..{5.--71� __. - -------------------------- --- ---------I—--------- ---------------------........;------------ 0_7`71 "--------------- Installation - -- - - - A_e - --- - PHP e HQ - --• - - v ..3.--1262---- Ins+alfa}iqn will serve: Residence pL] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [ Other ❑ Number of living units: ._ -_ Number-of bedrooms_..2,_ Number of baths 1----- Lot size Water Supply: Publics stem - -`-------------------------- Y [� Community system ❑ Private ❑ Depth to Water Table ..4,5- ft. Character of soil to a depth of 3 feet: Sand [IGravel ❑ Sandy Loam ElClay Loam ElClay ElAdobe ® Hardpan E]Previous Application Made: Yes E] No ® New Construction: Yes X] No ❑ FHA/VA: Yes ❑ No;c] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well._--_-.-_.._-Distance from foundation._... Exie ._.._ ---_.Materia L..__._________ a-ng No. of compartments. Size _._ ------ -__.-Liquid depth - .------ _ Capacity _ __ __ Disposal Field: Distance from nearest well. --_.-Distance fromfoundation p Y ERiB -- Distance to nearest lot line.._ .. ... ting Number of lines-------------__ .__-----.._Length of eachline--------------------------.Width of trench.--------------------------- Type of filter material--- _.__.-___..._Depth of filter material._--- ----_----_-,Total length-----------------,_-_---_----.---.- Seepage Pit: Distance to nearest well_._r10-, - Distance from foundation.... -.Or Distange to nearest lot line._5-t-.---_-t C3 Number of pits_ - 1 ___-Lining material---_T!OC$._ - Size Diameter_- __ Cesspool: Distance from nearest well. .-_.-_-Distance from foundation �"LS Deptn -��_ \ _.-------.._--Lining material__. ...-------- -------..-- ❑ Size: Diameter_--------..4------ - Depth_._._.--------------- -- -------..Liquid Capacity Priv i - ------ -. Ca acit _.----------------`--gals. Y Distance from nearest well.._,.__.- -. Distance from nearest building_ Distance to nearest lot�ne.- _ '--- ------- Remodeling and/or repairing (describe):..-_.. addInje Fil-x-er--agcy_- o,_exi@ting §yet@m -'- I hereby certify that I haveprepared and thgt' e w - - --------------------- - - ------ -- i--.-` -- _.. - .. - ---- ---- -------- ---- - -- ------------------ Y y this application rork will be done in accordance with SanlJoaquin County ordinances, State laws, and rules and regulations of the San Joa uinADcal Health District. ( g ) k S (Signed) 13141T t .•• mnn Sr [•P,y jrLC (Owner and/or Contractor) By: P-rsry.. Q. 1�[arLhaq f - - (T+le) Gen. 149r.9 (Plot plan, showing size of lot, location of, system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - - --- -- -- -- ------ - '--. APPLICATION ACCEPTED BY __.-. ` . . Y _ ,�--_- REVIEWED BY........ - ------------ '�. -:/ --- -- - Dr1TE- - - - -- � -- - Dl ISSUEDNG PERMIT - - - ---------- ------- ---- ..-..-.. ----D.LA�.E..... ---- - --- ...-- ---- -Alteraions nd/or recommendations:... - -- LI c ---------_--------- . _-- -------------------------- - -- - --------------- --------------------- .._.... -------------------------------------------------------- ----- -- ----- -- -- ------ --- ---------- -- -- --------------- FINAL' INSPECTION BY:.-- -... -- ------_--- Date------ -/ Q. .2,_..----.-. .- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street itockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Pev,s-d 6-'59 F P-Co-