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� rvK Vrrll U t: �_ - APPLICATION FOR •--- .... .-- • ... .---- ON PERMIT Permtt N r o. (Complete in Duplicatel ..... I..... ----•- ---- ......... This Permit Expires 1 Year From Date Issued Date Issued _5:_ 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 CATION........... ,�/ _ ........(.�� - -... ' .....................•----•--...----_._.. Owner's Name.....-_----. .... ' �~•: .S4_ /.11/f.�,�-•--•---•--•----..._.. . • --------•......................................................... Phone--- Address-------------------------> ......................- ............................................................................................ Contractor's Name............... L-. ------------ Installation will serve: Residence ❑ Apartment House E] Commercial Trailer-Court ElMotel ❑ Other PC CJ z Cc Number of_1i:ci>sg units: ----1_ Number of bedrooms Numlu ber of bait---2- Lot size ......../sem-G.---_-.1f..34 Water Supply: Public system ❑ Communitysystem Private Y ❑ � Depth to Water Table _��Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date....------ _ J No jg( 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-.A?s_Q.. Distance from foundation_..IQ-�: Material_.__. No. of compartments............,7........_.Size_...._`L��(3.:X_.S'..Liquid�depth_..._.. X1.__..____.Cepacity-4.:04.0_-• I ' Disposal Field: Distance from nearest well.,7570./.._Distance from foundation.___., Distance to nearest lot line �I .. �5_....._ Number of lines....................../.._. .....Length of each line._.. ----. .Cf �:'..Width of trench-_..__._.__�<�-__.•.------•••- Type of filter material._.._�rr . -....--Do th of filter material....__.. '� Total length.............. ]C?............... Seepage Pit: Distance to nearest well... ..._.,Distance ft /Joundation....._..ZP-------Distance to nearest lot line___..t"�- Number of pits.............1------Lining material..../..._..��-Size: Diameter__._.__33.�;.....Depth.'..-...... ?S:-r__....•.- } Cesspool: Distance from nearest well-----------------Distance from foundation_. ___ Lining motorial !:.'......__`_ ❑ Size: Diameter. ...--------Depth------ ---------------------- -- .......-------_------Liquid Capacity_.... -.___----••gals. Privy: Distance from nearest well............................................. _Distance from nearest buildin ❑ Distance to nearest lot line............._............ _ building.......................................... _....._...... • . ......................._--------•------•---•--•------•- - Remodeling and/or repairing (describe):........ ...... ----•••---------------------------------------- ................. ....................... -............................................................................................................................................................................. ,.,,_ 1 hereby certify that I have prepaPed this applicatiori and that the work will-be done in accordance with San Joaquin County ordinances, State laws, and rules and equl_at-ion�s of the San Joaquin Local Health District. (Signed)_ f 1. "'.. x.1... .. --__-- __........... ... _------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). FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY.......... .. . .................••- ------------------------- DATE._.. l=F< J C .c_�� 19c.__-. REVIEWED BY .......................... ..................................... DATE-_.. BUILDINGPERMIT ISSUED............. ................................................_...................................... DATE._- Alterations and/or recommendations:................. ...... ...... _ •. ........ ..... . ..< --- ..............• • ----....-•--•-•---•------.........._.......................... ............ SPECTION FINAL INBY: . ._..:l� i�•s - --..... . —Date.*.-. Copy r COPY fnr Gre•r uQlley pSAN JOOAQUIN LOCAL HEALTH DISTRICT r' i 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod[,California Manteca,California Tracy,California [8 9 REVISED 0-39 !M 3-61 A1LAS