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FOR OFFICE PS�F: ..- -.-.--- i-Q_/.t.�- ..-__1_ �1.c.,�4PPLICATION FOR NITATION PERMIT Permit No. .. __ -- r --'--.._ -------- ----- -- ------------------------- (Complete_in Duplicate). . 7d1j ll/ - Dote issued .______.,�_�`./.kz..7� - --------------------------------------------------------- This Permit Expires 1 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, JOB ADDRESS AND LOCATION---- . ._ Z.- ----------- 1 . Owner's Name....: ........ ---•-•------------------------- ----------------------------------------------- Phone-------------------- Address------- .......... n_1' - ----- AA.......... ---•--------- Contractor's Name.-----C:.W..3cLSY, ......----•-/" .... '•�'/ ... 1 �� --- Phone----------•--••----• -- Installation will serve: Residence Q Apartment F; I/ Commer ial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L. Number of bedrooms z-__ Number of baths Lot size ___A-2_...... ---------------------- Water Supply: Public system ❑ Communityrsystem ❑ Private C& Depth to Water Table 12. ft. Character of soil to a depth of 3 feet: Sand ❑". 4G;-ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application"Made: {If yes,date._--..-_..._-.___,)�Na �. .New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ®, 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....--_...---___................................ . No. of compartments---- --------------------Size................................Liquid depth--------------------------Capacity................. Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. ,,`�❑s. 1 Lig Number of lines-----------------------------------Length of each line-----------------_-------.•...Width of french................................... Type-of filter material-------------------------Depth of filter material----.------------------Total length................................._........ C- Seepage Pit: Distance to nearest well__6:L ___+-_Distance from foundation... .��...,___.Distance to nearest lot line....:` .�.... ®, Number of pits_______{______ --__Lining materialFi_ _,_..�Q_ _�Size: Diameter__`. ? .-��..._.Depth------1 7t_ f Cesspool: Distance from nearest well-----------------Distance'from foundation---------.............Lining material------------------------------------- El Size: Diameter-------------------------------------Depth--------r-----------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________________•_•_______-_-_-.-. ❑ Distance to nearest lot line----------------------------------------------------------•-•--------------------------------------------•------------------------------------ __- . Remodeling and/or repairing (describe)----------------- ------------------ --- .......................................... •-----------------•----------------------•------------------------- � . -------------------------------------.------------------------------------------------•-------------------------------------------------------------------•--•----------------•- --------------------- 1 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 re ul ,ions-of-the.San-Joaquin..Local Health District. J {Signed) = = J, - ----- ------ •-------------------(Owner and/or Contractor) By:--_--------------------------------------------------- -----------------------------------------------------------==-------------(Title)----------------------------------------------- - -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed on reverse side). ti FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY---------0--- ---------------------------------------------------------- DATE-----I-Z_- -- -------------------------- REVIEWEDBY--------------------------------------------- -----------=-------------------------------------------------------------------- DATE_...... ------------------------------------- -*"*'***'*'- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------- - Alterations and/or recommend'ations:_-110__-_4_-_6.3---------2�#..____a-e�-s ------'-----_g ----- ._t-�'______.14L.�t' _ i--------------- --------_-------------------- --------------•-----------------------------------..-......----------------------------------------------------=---•---------.._....-------------._.._.....__.... ------ •---•------------•-------•-----------•---•--------•-- ------------------------------ ------------- ------------•-•-------- ---------•-------------------------------------------- ------ ----------------------------••--------------- FINAL INSPECTION BY:-•--L'---= =------------ --------------------- Date-----I--- -------- :C° SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreef--- 124 Sycamore Street 205 West 9th Street _ yStockton,California Lodi,California Manl ce a,California K * Tracy,California E8 9 REVISED 8-59 2M 8-61'ATLAS -� +v