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FOR OFFICE USE: '1%' APPLICATION `F4R,.SA. TATION PERMIT f Permit No. -./ --------------I----------------- ---------- ------------- .. —(Completein.Dupiisetejr --------------------------- J This Permit Ex ires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549. '. JOB ADDRESS AND LOCATION.__-1- - --_-_ - ' --------------------------------------------------- ------------------------------- -------------- 7------- --- - L/Owner's Name---------ZQ.T_�.w-•------- -ft.�_rl_t�Y------`---•-------------------- ------------------------ -------------------- Phone_A/2--- ---7�-8 Address > i�_Yt�Q,... } ---------••----------------------------------------• Contractor's Name.... x�t. r•,« �? 5 -------------------- --------------------------- - _ -------------- Phone---------._----------------------- � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (] Other ❑ Number of living units: __l___ Number of bedrooms __;2-7 Number of baths'__�__ Lot'size :;5?ZX-16�r -- --_-- •-----------------_--_ Water Supply: Public system a[}— Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: + Sand [❑ Gravel ❑ Sandy Loam ❑ :Clay Loam ❑ Clay ❑ Adobe [T-Hardpan ❑ ' 3 -9 r� Previous Application Made: (if yes,-date____/.�'_f No ❑*r New Construction: Yes P/No ❑ FHA/VA: Yes e No ❑ k TYPE OF INSTALLATION AND SPEC IFICATIONS/ ��p' � (No septic tank or cesspool permitted .if public sewer is a vailable'within-200 feet.) ' Septic Tank- Distance from nearest we'll________________Distance:.from foundation__.____-__-_.t__._.Material__...__-_.-_._.______.__.___________._________. .V j� No. of compartments--i - --- Size----•---•------ ----.- '---Liquid depth--------------------------Capacity----------------------- , F N Disposal Fiel Distance from nearest well '�"-��-:Distance from;foundat on_=____ ©-__.Distance to nearest lot line__. ___. Number of lines___._s' f' `_ Length of each line''_____-,�` Width of trench____-- W �y Type of filter mater€aL__ 'O_� Depth of filter mater ial__.��_________Total length. Seepage Pit: Distance to nearest well °. -----------Distance from foundation-------------------- to nearest lot line_________-____.._ �E/ �f Number of pits ------.Lining material------ --- ------------Size: Diameter- ----------- --- Depth------------------------ _ , � 1 Cesspool: Distance from nearest well_________________Distance from foundation.__._________ -.`Lining material___..___.__.__.____.__._. _______.__. 0 El Size: Diameter----- -------------I--------------- Depth- ------------------------ -----------------------'`Liquid Capacity------------------------' gals. "1 Privy: Distance from nearest welL_'_____________ --------------------------------Mstance.from nearest building ❑ Distance to nearest lot line---------------- ---------------- --------------------------------------- Remodeling and or rep airing (describe:__ On _`L,fe___; ,e _f�-7! ---_L/1 -- - -XX-p- - --- -}� � --------- :. ------------------------------------------------------------ ----------------- ------------- -- ----------------------------"" - --------------•------------- --------- --------------------------------- ---------------------------------------------------------------- -1 hereb certify that I have repay d his application and that t work will be done in accordance with San Joaquin County ordinances, S to laws4an rule and r g a+ions of the San oaquin ocaLHealth District. (Signed)------------- - ---- - - -- -- - --•-- ------ -:"----- ------------ -----=--- and/or Contract - -- - - ---- ---"- wner o or) --------------_ _________________________________'__(Title)__________.._.----------------------------- (Plot plari,—aho rw ng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). '- FOR DEPARTMENT- -SE-ONLY i APPLICATION ACCEPTED --- --- ---- - -- --------------------- D�A _ -; REVIEWEDBY ------- ------------ -•--------------- ------- - ---------------- -BUILDI PERMITISSUED------------------------------------------------------------------- - -------------------------------- DATE_ Alterations nd/o co endation . -------- ----- ---------- 4 -- ---- - --_ A----- —___: __::_::: 7. :::_:_::___ --------------------------------------- ----------------- _ i _____-_____------------ ------ __________________________________________________________________}_____ ..._..______-____..___.__________.__.__-_---__________._________.__..._________________....______._......______..___.________._..__._- f FINAL INSPECTION BY:------- -------------------------- - ------ Date----------------------------- - Y. SAN.!JOAQ.UIN LOCAL HEALTH-DISTRICT 1601 E.Flo:el}on Ave. 300 West Oak Street- `� 12 Sycamore Street 205 West 9th Street . .' a Stockton,California Lodi,California Manteca,California Tracy,California } ES 9 REVISED 6-59 3M 3-'63 F.P.CO. ;