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r ------... �,^°�.ICA`(I�N FOR $ANI7ATION PER Permit No. ............� D ....................................... --•---..-- (Complete in Duplicate) ----------------------- .. --.... I Date Issued __....f./. :_ Z This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to lst and in II th ork h escribed. This application is made in compliance with County Ordinance N 54% / 0 JOB ADDRESS AN LOCATION.`Jr �V , , - _ .. __ ._j- ._�- --__---_ _ __ ______________ ___ Owner's Name------ ------�-----�---1 ' Phone - - - ---- -------•--._................----------••-------•----. -- Address_______1-23_4� )ntractor's Name ' - - .......................... . Phone.---. .._. lstalletion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer rt ❑ tel ❑ Other Number of living units: -------- Number of bedrooms -. --._ Number of baths.__. Lot size __ _ ----- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ CI ❑ Adobe H` dpan ❑ Previous Application Made: (If yes,date.-.-..-.__-. ---.) No ElNew Construction: Yes � FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i blit sewer is available within 200 feet.) i Septic T54 Distance from nearest well/, , . _---- - istan from un at' n__-R.Q__._.Mat LV{__ c----- .. - � rte---- ••-----••-- -• No. of compartments..-__.-_ - __._---.-_Size.SZX-S .EtLiquid depth__-_, ?.---------Capaci Disposal P re"I'd: Distance from nearest well . __ --._Distance from founda ionAo--_-.....Distance to nearest lot Number of lines.____ . Length of each line-�.Q-___-_- -_--- _.-Width of trench......r�y."--__-_-___i.. Type of filter material_ � C -Depth of filter material...__$._...-_.Total length---------------------;711! -__ Seeps it: Distance to nearest well-- _ _-,J --Distant m fo dation.,R.6r-.......Dis ante to nearest lot line...SQ.._.. Number of pits___p ._______...Lining material_ !Q' ..Size: Diameter__- _.Or _ De th___-- _S-____.-_.___ Cesspool: Distance from nearest well.................Distance from foundation....................Lining material-.................................... ❑ Size: Diameter--------------------------------------Depth....................................................Liquid Capacity---------..........------.gals. Privy: Distance from nearest well.................................................Distance from nearest building.............................. ❑ -- Distance to nearest lot line/----------------�--••--••----••--------------- -•--------•-- -----------•-------•------ ---•--------•----------..._........._..••------ Remodeling and/or repairin (describe):..___` ----- v ''� - -- .` •-- -•-•-•---------•--•--------------- ------- -- ---- ------------------------------•---••-----....-----------....__...---_... ...... - ->--------------------------------------------•- ...---------------------------._{j..................................................................................................................... . I herby certif hat I have prepared this application and that the work will be done in accordance with San Joa Joaquin q County ordinances, S ate and rules a regulations of he San Joaquin Local Heath District (Signed) . . . . ......%...... - ------------ -. inand/or Contractor) BY:----------------------------------------------------------------------------------------- - - itis)---------- -- _ ... .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, a can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. _ __________________ .Y_. _.. 1,.. DATE_-__...___ REVIEWEDBY............................................................................................•- ------ DATE------------------------------ -------------------- ....... BUILDING PERMIT ISSUED----------------------- _._... ® - .1 - -----.-.-_-.-.-.-.--- Alterations and/or recommendations•_ - . E ------}--- ---- -.---�--3-.-_ __ .c�. L ----------•---•--••-•--•---------------------•...........--•--•----•--•-----•-----•----...--•--------------•-------------------------------------•--......-•------•--------•-•-------------------•---------••---------------- ----•..................•------••------------•-----•--...---...------•-----•.........--------.............-•-------•---------•----------•--------•--------...--••------------•------•------...._..._.............----------- . -•-•-----------------•----------•-•------•---------------..._.....---•--. ----- --•-----••-----............................................................... ..................... .................................... FINAL INSPECTION BYL - Date_ -- ------------------------- SAN JOAQUIN LOCAL HEALTH DIST T r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl, California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-61 ATLAS