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APPLICATION R SANON PERMIT lti Permit No. (Complete in Duplicate) 1 $ Issued __ _4 D j This Permit Ex ires 1 Year From Date Issuedi Application is hereby/Lde to the San Joaquin Local Health District for a permit to consMru # an ,in/stall the work herein described. E This application :made in compliance with County Ordinance No. 549. e / JOB ADDRESS AND LOCATION_____ -- - --- y -- _F-61 --,--- ------------- --- Phone Owners Name------------- --- = �C!1 1P1 t k �Q L - r--�-------------------------------------------------- Address----------------------- J Cantrac#or's Name o �'`� -------------------------- Phone - ---- ---------------------------- Installation will served Residence Apartment House ❑ Commercial ❑ Trai r Court ❑ Motel ❑ Other ❑ �� -Q---x - -- Number of living units: __- T"NLmbe�oofbedroo`ms __ lNumber�of-batk�s-_ - -Lot side ..__-___�- i j Water Supply: Public' system ❑ Community ,system Private ❑ Depth 'to Water Table I --___ ft. f-3 et:. Sand 'Gra el ❑ Sandy L oam ❑ CIayL'oam ❑ Clay ❑ Adobe�ardpan ❑ Character of soil to a depth,a,. w !# r ,�o, , I 1 l Previous Application Made: lies Igii NeiTConstructlon: Yes'❑ No [ �i Fl-iA"/VA: Yes ❑ No ❑ TYPE OF INSTALLATION',AND SPECIFICATIONS: t available within 204 fee�: [No septic tanik or cesspool permitted if public sewer is yH F _.-_-DistanFce from oundtion_ D-- 11'x'Meat ri ._ _ '--dam Septic Tank: distance from nearest well___ , _- _-- -. t `` Ca acs -7100-------- . No. of compartments--a4___' Size_--- Liquid depth-----J----- ------------- p tY 9 I ------------ �J�._ Distance to nearest lot line- jj �# Disposal Field: Distance from nearest well ____�1__-_Distance from foundatri�on__ -_ -hill g I �¢ 5 ,fqly- ;_ �idfh of trench-------��--------------- Number of lines________________ ______ ___________ en th of each line ___(_ T, e of filter material__-S_+ -_ _ Depth' of filter material:" D Total length_________,.� _Q-------------------- ! Yp i Uk r� t Seepage Distance to nearesf well_.--_ "'- 5Distarice from foundation_ ___________Distance to nearest,lot line_-__-__.__.___,__ iNil �- '- Sze: ameter--------- -------------Depth- -.__-_-- ----------------- Cesspool: Distance from nearest well_:�4-_- __ __ ist rice foo i l�umber of pits__-__-_--___ ____- Lining materr f"' -_- - � rri foundation._ Lining material Ces p ----___Li Liquid Capacity --------------------gals. Size: Diameter-------- ---------- -----r--�=,_,. i ept -------------------------------------- 0 q p Y -= ; Privy: '---------------------Distance from nearest building---------------------------------- ------ Distance from nearest welh•.__________:-__.__--- 1 ------------------------------------------------f ❑ Distance to nearest lot line-----------------�------- ---- - - -- --------------------------•----�--------------- t s Remodeling and or �e airing (describe):__ __ Q------- C S �C�_(--,e �e-A._t-r-�-------6--C-�----------------- ---- � ` � e?� _ _ ;.. �l _-_�_ �_�n --------- ---------------F- -- _ -- ---- I --------- ------xi- `.---A W-1 ��.4�_4_e. � h: �.-------- Q,�_. 5------{ ----- �f 1r Pyr�+r.e' e:* ------ 3 ---------11 --- - - -- - I hereby certify!that I have prepared #his a plication and' that the wortwill bed a in accordance with San Joaquin Cau ty ordinances, State laky an rules and r ulations of the San Joaquin local Health District. ------------------------------------- ____------(Owner and/or Contractor) ----- - ------- --- -- ----- ------------- ---- M I 4Y: =--------------f ----------- ---------- (Title) } # [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. I FOR DEPARTMENT USE: ONLY r i DATE------------- y +� APPLICATION ACCEPTED BY � DATE------- - -- -------------------------------------------- REVIEWED --------=-------------------- ---- REVIEWED BY------------- _ ;,_, .,- - -------------- k------------------------- -{-------- DATE BUILDING PERMIT , { _ ---------------- Alterations and/or recommendations:------ ------- - --`------------------------------------------ = _ - ------- c" 1sJ -- ---- h ----- ------------------- ------------------------- - ��.r�r� ------------- I � e } --------- ------------------------------------ FINAL INSPECTION BY------- ------ ---- •------------------------------- : -- -- � �` -------- SAN JOAQUIt4 LOCAL HE STRICT 300 West Oak Street I Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca. California y ES-9-2M Revised 6-'59 FLP Co' -��.