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APPLICATION FOR • NITATION PERMIT Permit No. ., . (Complete in Duplicate) I / ' !`k-, � rT ' i~ • � Date issued -----1- ------ --- 1 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. S ----------------- � � - JOB ADDRESS AND OCATION-------- /---------- --------- --------------------------------------------•------•�--ff,,-„------------------------... OwnersName------------ - ----- -- -:------ ""f -----------------••-------------------------- --------------------------------------- Phone__0_t----Yt-S�__Q_. Address-------------a.A,- -__Tx -•-------- -QQ---------_�---------------------------------------------- --------------------------------------------------------------...._------------------------------ el-. --------- ------------------ .. Contractor's Name .��_` _..-•-____-- ------ Phone- ---3r_�-Y_ -- -._.- - ------------------------------------------------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms __Zr__ Number of baths ___I___ Lot size ___jD�_ _L _v______________________.__--__ Water Supply: Public system ❑ Community system ❑ Private 2--Depth to Water Table.__ ft. Character of soil to a depth of 3 feet: Sand ❑Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes i?' 90 ❑ FHA/VA: Yes ❑ No{�i' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep�tic/Tank: Distance from nearest well-,�Q_�________Dista ce from foundation_______ _.___ _ MaRerial__ .._____ 2 No. of compartments____ �_--_______-Size_�_�. ___ __�---44 Liquiid,Tep h___ ___�"_3___-_____CapacitY___ �'_. Disposal Field: Distance from nearest well------- -_.:-----Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line-----------------------------.Width of french---------------------------------- Type of filter materL________________________Depth of filter material__________-_..______-Total length---------------------------------------- ( ________-._____._-.__.______._______-. See,p�.a��ge .it: Distance to nearest well____7S_-_f”---_Distance from foundation__ _ Distance to nearest lot li e___�___--- Number of pits.__.!_________________Lining material__ : r_.__.Size: Dram ter____. _�..._._._ p . De th � ----------- Cesspool: Distance from nearest well______- Aistance from foundation___________________;Lining material---.___._..________.___.___...__.._. ❑ Size: Diameter------------------------------------y,Depth---------------------------•------------------------Liquid Capacity--------------- -------gals, 400"'4rivy: Distance from nearest well------------------------•-----------------------Distance from nearest building______.___.___------------------------_--. ❑ Distance to nearest lot line------------------ -------------------------- --------------------------•--------------------------------------------------- �} Remodeling and/or repairing (describe): - ----- - L ---- . - 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. (Signed)-----�-a ----- } ---------------------------------------------------------------------------------------------------------------{Owner and/or Contractor) By: . ---•---- - `'.- ' (Title) Plot Ian, showing sizot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- ----------- ----------------------------- ----------------------------- DATE ---- ----------- REVIEWEDBY------------------------------------- ----- - - --------- ---------------------------------------------------------- DATE--------- BUILDINGPERMIT ISSUED---------------- --- -- ------- ---------------------•--------------------------------------- DATE----- ---, -------------------------------- -----•-•----- Alterations and/or recommendations:----- - -------•------------------------------ ---------------------------------------------------__------------ -•----•-.......------------------------- -------- ------------------------------------n�7.....? PTi't esu-A? ------a6..... �------- ,5! .fir -------•------------------------------------ 1Ul S rinNG 13 £/.�1 ' i�l------ ��''�-------"�� ------ ---------------------------------------- �' ^9' F _es- _1 !�1- At --------•'nom r'` x` % �' f = � �— 7' ,r be A�4 �i�� k)Al- eccl �, i�- CocJ&,Pe-s, &AAA -4 -A A -'7-.. FINAL INSPECTION BY:.----_ .rs - ------- Date---------,.t-r---� - `'S`�� ----- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California h ES-9-2M , Re'7 F-P.CO. f