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R FICE USE: � � Permit No ---_-------�.a S� - -- APPLICATION FORSANi 'ATiON PERMIT" -------------------------------------- (Complete-in Duplicate} Date Issued ------ 1 / -----I-I.-------- -. 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. JOB ADDRESS AND.LOCATI N1 erb D__._ Owner's Name------- l Address----------- _ L� ------------------ Phon�7`-�'��- Contractor's Name-------------------- Installation will serve: . Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms _rR_ Number of baths -�_ Lot size -_#_ ___________________________________________ 1-1 Water Supply: Public system El Community system ❑ Private 19 Depth �Wate.r Table 8'D ft. Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑.Clay Loam* Clay�❑ Adobe❑ Hardpan ❑ i , Previous Application Made: (If yes,date---------------------_) No ElNew Constr ion: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I i i 6�1e Tarsk: Distance from nearest well______________ fro __Distance m foundation-------------------- Material_..___..___-__________..______________.,_________. No. of compartments------ --- -----------Size_----- --------------------y Liquid depth---------- -- -----------Capacity----------------------- - 6 R__0---------- to nearest lot lin _v ------------ Disposal .____ _. Disposal�,Id,>/Disfance from nearest well._��?___-_.Distance from foundation__c _.-_Number of lines-------/------------ ------------Length of each line---- -- -I--------;�---Width of trench.------- -��-------,------ 0 Type of filter material___5,F__/RQ_C_A<---Depth of filter materia!____.__ ------.Total length---------------------- - ---------- 1 ' t . � ;Seepa a Pit: Distance to nearest well—A04---_ --Distanc rom foundati( n__ -t�.___._..Distance to nearest lot line_' __---- a Number of pits------ ______________Linin material_ �C_ ' Size: Diameter--- __1�-.--------Depth______ _----------------- Lining� � r Cesspool: Distance from nearest well _Distance from foundation----- -------------.Lining material------------------------------------ ❑ Size: Diameter: -----------------------------Depth------------------- ---- - -- Liquid Capacity gals. - f Privy: m Distance'rom nearest well--------------- -------------------------------°Distance from nearest building_._____.________________________----.__ ❑ Distance to nearest lot line-- ------------ - --�---------=---------------------------------------------------- A -------------------------------- - Remodeling and/or repairing {describe}:___ --------------•--------•---- •------ -------�----------•---- t -------- -------------- ---------------------------- ----------------•----------------------- ------- I hereby certify that I have spared this application and that the work will be done in accordance with San Joaquin County ordinances, S ws��)re ules nd regi+i ions of th n1 oaquiWLo l Health District. ---------- --------_ ----- ---------- (Signed) _._- Owner and/or Contractet) • By:----------------------------------------------- -----y---------------- ------------------------------------------------ -------(Title) r-------- ------- --- (Plot plan, showingsize.of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- / -- /--�---------------------- APPLICATION ACCEPTED SY -- ----- -- -----`tip- / 7i` REVIEWED BY---------------------------- ----------------------------- ----------------------------------------------- -------------------• DATE----- ------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------- ----- -----------------• -------------------------- ------ DATE----------------------------------------------------------------- � ��.--------=�--�---�=--- --------- ��-Z `-cam Alterations and/or recommendations:.______.__ --_ ._ •--------------••.. - - ----------------------------------- --•------------ ------- --------------- � , -------------------------------------------------------------- r. -;2 `. �'-u�-•- ---------- fflkl�CT - -------------------------- FINAL INSPECTION BY........�_Z_ 5AN JOAQUiNLOCAL-HEAL7 > 300 West Oak Street s lR4 Sycamore Street 205 West 9th Street y 1601 E.Hazelton Ave. a r ' Stockton,California lads,California *. Manteca;Ca(ifornla Tracy,California S l E5 9 REVISED 8-59 3M 3-'63 F.P,CC.