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FOR OFFICE USE: - APPLICATION FOR 5_ t No. AN_ITATION FERMI Permi -----_-- (Complete in Duplicate) Date Issued ;-nZ `------� ------- ,,. -. This Permit Expires 1 Year From 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. X05"..�°��a 51. ------------------------------------------------------------------ JOB ADDRESS AND LOCATION------- -•-------- Phone------------------------�a �Owner's Name---------F -----J. -- Address-----•--------_--.-- S9'� '�' j�O,�j/Y)"�l _ ------------- Phone----------------------------------- Contractor's . - - -- Contractor's Name-------- -----Aued------ ----- ------------------------------ ----------- Installation will serv� Residence � Apartment House ❑ Commercial El Trailer Court ❑ Motel [I Other El $fig Number of living units: _-�----- Number of bedrooms _-�... Number of baths --�-" Lot size ___-.--�--Z�JC- Water Supply: Public system �fCommunity system ❑ Private ❑ Depth to Water Table "yv" ft. -.4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-..........---------) No [j -New Construction: Yes ❑ No El�_ 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--..__ -_---Distance from foundation" -_.IQ--""""--.Mated". @YlG----'alk!-gpiJ No. of compartments-.--- . . '�S'`-��------ -•---Liquid depth_---""""'q*� --.__.Ca acit - - °s�.--------- -.Size-----•---�- - - p Disposal Field: Distance from nearest well..- Distance from foundation ""Q3----------Distance to nearest lot line...6----_--- Number of lines----------------- ------Length of each line------_A-a'-"--'=-------Width of french.-.-----�--------------------- Type of filter material"S-RUtk------Depth o �- f filter ma ----- terialTotal length--------p9p-------------•---------- - --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line___-.----------_ ❑ Number of pits------- --------------Lining material---------- ----..Size: Diameter-------------- --------Depth------ -------------------------- Cesspool: Distance from nearest wel --------------- from foundation--------------------Lining material--------------------------------- gals.❑ Size: Diameter---------------------- -----.Depth------------------------------------ - -------------Liquid Capacity-...---------------- -----g Privy: Distance from nearest well----- -----------------------------------•------ -Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----------------------- ------------------------------ -------L1+ /J�J -Gzp Remodeli g.and/or repai g (describe}: L2 �f r�r� ------ �'1� r - - ------------ -��. . -= -------------------------------- -.--.- -------------------------------------------------------------------------- .----.-.------- 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 r gulations of the San Joaquin Local Health District. (Sign ed -------------------------------------- -----------_- ---------(Owner and/or Contractor) 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 APPLICATION ACCEPTED BY- ------- DATE."." -LJ y66 - REVIEWED BY..---- ---. DATE------ ----------- ------ BUILDING PERMIT ISSUED----------- DAT ---_ � �` ---- Alterations and/or recommendations:--.. - 1V_-.------ -�� ✓r- �� '! �s�ciza" -----.------ _.7---�-- C w -- -------- ----- -------------------- e �- FINAL INSPECTION BY:. ------ Date------ ---------------------- C�11 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.