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FOR OFFICE USE: cD ApPLICATI01v� FOR,; S .. Permit No. Q - 4ANITATI4N PERMIT ........... -- f -b-69 ---- ------ ---" (Complete-in Duplicate) Date Issued --- .--••- ! -- This Permit Expires 1 Year From Date Issued -------------------- ------ is hereby made to the San Joaqui, Local) Health�Districtrifo a permit to construct and instal! the work herein described. 49. This application is made in compliance with County �}(CU�C ----------------------------------------- JOB ADDRESS AND LOCATION-- ----_S------Ti - -- Phone-....N�.�-------------- - 1 ------------- -------- Owner.s ame -�--- -------------------- Address --._-. Address----------------------- •---•-• ----•--•---------•-------•------------------•---- ------ •------------••------------- - Phone Contractor's Name-. ame _k --------- -------� - ------------------------------- ------- -------- ---- _ Other Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Cour} [] Motel ❑ - P1 ...2�._1Q_------ Number of living units: _- -_ Number of bedrooms -- Nurneof baths _-�_- Lot ssze __..- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ._.___ . ft Pp Y Y I� -....,,r.__ -c .- . �Cla Adobe K Hardpan ❑ Character of soil to a depth of 3 feet - Sand-❑"Gravel-❑+'SandyLoarn-❑`Clay Loam ❑ y ❑FHA/VA: Yes ❑ NOX -1, ---_. No�,( New Construction: Yes No ❑ Previous Application Made: (if yes,date_------------ } Ill a•i;- TYPE OF: INSTALLATION AND SPECIFICATIONS: ' 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -..Material ...__ ?? -------------- Septic Tank: Distance from nearest well-----------------Distance from foundatin_ --de-depth Capacity.______________"'_.... ❑ %?CG '%VQ6 No. of compartments...- ----- __Size-----_--- Liquid �p - Disposal Field: Distance from nearer welL�PY ..Distance from foundation__�Q.- ---•----Distance to nearest lob line______________' Number of lines -------- ------------------------Length of each line--.----1QL��------ Width of trench...__- ---- ---- ---- --- _ `=Total length Type of filter matenaL��.--��Y�--Depth of filter material=___�_-____r tY - ----•---- Seepage Pit: Distance to nearest well_.'R:!GN_�-." ---Distance:from fo�ndation____�_-•�_____________Dir#ante to nearest lot'line K fr De th o`LS- - ---- Number of pits.-- --- --------------Lining material-SO--W Size: Diameter--- -------- --- Number -- p Distance from nearest well ----------- ----Distance from foundation..--------- ----- -.Lining material_-. '------------------------------ Cesspool: -_Liquid_Capaci.ty_c------------------------gals. ❑ Size: Diameter` ----- -- -- --- Depth Privy: Distance from nearest well_ .Distance from nearest building---_-_ r� ......... ------- ---------;--- ❑� Distance to nearest lot ine ..._--.-.- - , --- - -- - - - ------------------ Remodeling and/or repairing (describe.:--"rr. -- ----------- • ------------ - ----- _ lCounty ---------------------- ---------------------•----,------------- ------ ------------------------------ -- I hereb certify that I have`prepared this application and that the work will be done in_accordance.with San Joa uin ordinances, State laws, and rules and regulations of the San Joaquin ----_-- wner and/or Co {Si ned = = ----`------------------------------(Tit •g ) stem in relation to wells, buildin (Title)--------------- - l buildings, etc., can be placed on reverse side]. (Plot plan, showing size of lot, location of system IV/ FOR DEPARTMENT USE ONLY lDATE.._—, _�.�--.�------------------- -- t APPLICATION ACCEPTED BY__ �U = :r' ` - . .� �. `DATE------r------------------- - ------------------------------ F REVIEWED BY------------------- ----- ---------- - ---------------------------- ------------------------------------ --- ----- ------ DATE............................................. ------------- BUILDING PERMIT ISSN -------- -------------------------------------------------------------------------- ----- ---- ---- ---------------------------------------------- ------ Alter dos and/or recommendations;_---- -------- ------- ---- -------------------------------------------------- -------------------------- ------------- --- -- FINAL INSPECTION Y:---------- -- _ _ --- --- Date--- ------ - -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 20.5 West 9Th Street `1601 E.Hojellon Ave. 300 West Oak Street Lodi.California Manteca,California Tracy,California Stockton,California E.H.92M 1-67 Vanguard Press V ; F