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�........... ... ............. APPLICATION FQRrSi-NlTATION PERMIT Permit No. .o`� ............:....... _.------------------ -------- (Compleie•in Duplicate) .--- . .. This Permit Expires i Year From Date Issued 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.6 . ....... " ' OZ( - [ O-oS --------------•----- -- ........ Owner's Name._ +��r -�1 '� ------��-----�..,�--�--�- •---------.............. ..........._ ...........-----...................----._. Phone.......... Address----� -_ -•-- �•�� ^'� ....... Contractor's Name._ ... � 1t� C1��S,.��1�;;A� Installation will serve: Residence ❑ Apartment HouseCommercial LlTrailer Court x Motel p Other ElNumber of living units: _.._lumber of bedroomsA__. Number of baths ..._ Lot size ..... _._ `�-L-� ftW1_�'� ............ Water Supply: Public system ❑ �ommunify system ❑ Private*0 Depth to Water Table ...... _ ft kAIJKI-Y-'W4 Character of soil to a depth of 3 feet- Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Ie Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;dgte_s_ .:_:._ ) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) j •�„ Septic Tank: Distance from nearest well.__ Q rk,.Distance from foundation--.1G.--._..._ Material .. � . `�------------ - No, of compartments...'1*; r ..._Liquid depth.._!(1=�_.. ......_...Size. ?�. h ... .._....Capacity----- -�(N i ii � � Disposal Field: Distance from nearest well.(C>:+�._ _..._Distance from foundation__�.Q-------------Distance to nearest lot Number of lines .......T!1.-0f................Length of each line.. ... .�..._.........Width of french..-, / .._•---- Type of filter material. ?' K-.,Depth of filter material____.�5 ��--_".----Total length....... Y ......................... Seepage Pit: Distance to nearest well------- ------_.._--.Distance from foundation_____..---.___..__..Distance to nearest lot line._.-----•,-••--,•; .f0: - _.Lining materia! l 'Dumber of p,ts- ----____-. .. ............. Size: Diameter._..._..---...---.• _-- Depth-----..-••- _ Cesspool: Distance from nearest well ......... from-foundation-----.----------- Lining material.............. ......................❑ Size: Diameter. .. ... .... ... ................Dept h----------• -- --- - --- --------- -- ------Liquid Capacity- --- ------ Privy: Distance from nearest weiL___.................................__._..."-•Distance from nearest building---------.._--------------- ------------ ❑ Distance to nearest lot lire---- •. ...... Remodeling and/or repairing (describe):__ _ 'fa�k ----- 1.._.. n � 11...5ti;a.1~ -- ---------- -------------- .--------- -----------..------- --------------------..----------..._..._..........-._._.. __.......... ....... ----------- . ....... ---- . ..--- . I 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 regulations of the San Joaquin Local Health District. 4 " (Signed)___._ .---.....__.............. -----_----.---(Owner and/or Contractor) By:-------------------------------- ---------- rifle (Pl of plan, showing size of lot, location of system in relation to wells, 6u3clings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 G-s�.." :�1 -- DATE.- VIEWEDBY.. ..._--•----- -------------- ----- ----...._.._...-_..._ ............. ----- DATE-- BUILDING PERMIT ISSUED-------- -- --------------- ---_-----•-- ------------------ ---------- DATE................... Alterations and/or recommendations:----------------- - - - S. � .a. ., -� '-- - .. - r - -- --------- _--- - ( ��.. ------ --�� - - �r ............................. _ .. _S. FINAL INSPECTION BY:... - -------- Date---------- --- SAN JOAQUIN L L HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornlo Lodi, California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press • o