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FOR OFFICE USE: = l � ; x � APPLICATION r FOR S..-41fATION PEWIT Permit No. - ------------------------ ------------------- ------- - (Complete in DC-plicate]' Date Issued ...1� --------------------------------------------------- This Permit Expires i 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,made,in-compliance with-County Ordinance No. 549. 5m of 4 G'.4/►-j JOB ADDRESS AND LOCATION.... 1/!f -1 `"::....../-_... �r r C' � ! ` -•---.....--•--- Owner's Name_. G _ N4 �•' / ------- = Phone A - Address g - .._... ----•..... . ............ 4 r- Contractor's Name-----L-�-----km-- �h �r y� � �G- � 'l©. F-5 O ------- Phone.- -�!_"r4p.4'_._ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living Number of bedrooms _"_._.- Number of baths ____-__- Lot siie:_�'_. ..�=.....` ---`--`--/�---•--"-"__._ I Water Supply: Public s e am'munity system ❑ Private ❑ Depth To Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 1 , I Previous Application Made: (If yes,date--------------------) No,® New Construction: Yes 14 No ❑ FHA/VA: Yes ❑ No l?' 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___________________ _ _ Material--------------------------------. .59 No. of compartments-------------"."_________Size_ yf Liquid de th__________`�__.___..___.Ca acitY- - � y9K.! Disposal Field: Distance from nearest well_________________Distance from foundation-------------------.Distance to nearest lot line................. `o Number of lines-----------------------------____--Length of each line---------.-•----•-••--____--•.Width of trench.--- --.Y_______.__•--_.._..... Type of filter material-"______________-__.----Depth of filter material___ f_......"_.._..Total length_-__ _✓ __---_"__-"_.--_-••__- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line."._--_"-_-__-._ ❑ Number of pits----------------------Lining material.---------------------Size: Diameter------------------------Depth----------------._..---------.--- Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material______________-------------------------- ❑0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------....gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building."___"_--._--_---"---___-_-_________.___.. ❑ Distance to nearest lot line----------------------------------------------- -------------------- ----------- --------""-----.•---------------------- Remodeling and/or repairing (describe):---- �. ---------------------------- --------------•-----•-------------------------•----------------"--------------------------------------------•-••-.."..-----------------------------"-•---------•------- ---------------•--- ------•--------------------•----•----------•--•-----------•-•------------------------------------------- •------------------------------------------------------------------------------------------------ ---------------- 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)-• --- ' AIY" /7_alY�/ © ------------------------------------------------ ------(Owner and/or Contractor] By: � = -----------(rifle)----�_.0 �/ f f__�. `....... .......... (Plot plan, showing sire of lot, I n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------------------------ -------------- I REVIEWEDBY.....-----------------------------------------------•-------------------------------------------------•-----------.......... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:- - j........ ----------- -• ------ --•-- a.1��.. -r7 -----r -------- ._.. -- ._._... - k FINAL INSPECTION BY:. .___ ! Date... .l_. ._lr. .____... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS r