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rK L /!�S `. APPLICATION FOR „gNITATION PERMIT y�r �� Permit No. ______________________� ..._ (Complete�-in�Dup'tate) F_ � ,.,_..-�...�....�.._. —.�: �,..�..,�_r._..� ....•_ at su ,mac e Is ed . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc`rib4' his application is made in compli�nce with County Ordinance No. 549. E C' OB "ADDRESS AND LOCATION.'---- - ---fi7q-"-ZDOI/a ----------------------------- Owners Name / � 1---'/ '-- °--------- Phone- Address hone_ Address_-___.f��___-. _ q�- - I Phone T3f� ----------------------------- Contractor's Name----- t r -- Installation will serve: Residence ,)q Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ rx ' Number of living units: ___ _t_-'Number of bedrooms __ _ tf � /,-'Number �__ Number of baths __-�__ Lot sae --�-----------�-�-P��-----W er Supply: Public system ❑1 Community system � i - � $ 4 y y ❑ Private � Depth to Water Table��ft. r Character of sail to a depth of 3 �eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobbZ Hardpan ❑ • � r Previous�Applicafion Made: Yes No IN New Construction: Yes ❑ No M FHA!/VA: Yes'❑ No TYPEi j0F,INSTALLATION AND SPECIFICATIONS: �k(No' septic-tank_. or`cesspool permifted if public sewer is available within 200 feet.) � l • Septic Tank: Distance from nearest well________________Distance from foundation--------------------Ma;teriai -------------------- No. of compartments--------------------------Size--------------------------------Liquid depth------- --------Capacity------------- ---------- IDI " �- r Disposal i.eld: Distance from nearest well--------------- _Distance from foundation-------------it------Distance to nearest lot line_____ ____ `. i i Number of lines'--- -----------------------------Length of each line--------------- ---- -----.Width of trench--------------------------_�� Type of filter matdrial---------- a Depth of filter_material. Total length---------------------------------=�� Seepag Pit: Distance to nearest well__f48___.!--Distance E _ ❑ from fo ndation_w rf___.Distanc e to nearest lot line ,,l p• s -!--/---------- material- - im � - Size: Diamefer._ � _ Cesspool: Distance f,omneaest well_________________Distance from foundation_ _ ______ _Ling material------------------- , - in ---------- S ____.__--_Siameter + rti Depth- ----------------------------(-----Liquid Capacity gals. C-" Privy: + ( _i �_ y: .� Distance from nearest well---------------- --------------------------- Distance from nearest•.buii.dm r . ....�--- r g -- ✓ Distance to nearest lot line_____ __ ____________ t -tea Remodeling and/or repairing (describe];----__- x �_' ' '' 4 ' - =x�= -----------------------------------�------ i A i• F y 4 ---------------------------- d r _ �• f - i ,vi ---- r------ -------f---------------------------------------- ---=- --- - - - ' --------- i ' --ri -- �. - - -- ------- -- ---------- ----- -- --- -- --------f----- ----------------------------------- v - - - -- ------ I hereby certify that I have prepared 'his application and that the work will be done in�accor�•dancewith San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. :.. (Signed ------- [ ' s ; — iiG�-- = (Owner and/or Contractor) B ' _ I Y ��- -= (Title)--- ----------- tle) M - - - - - - TI 4 plan, showingof lot, location of system in relation to wells, buildings, etc., can b ► -------- (Plot Ii.i be placed on reverse si � FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BYc__-.-_-_�1_- ._ --- ---- DATE I ----- -------------------- r ________________------- 3 _-__ ________:____._ BUILDING PERMIT I ------------------------------------- DATE EVIEWED By _. I -- SUED ` ---------- - { - ------------ D Alterations and/or redommendations:_.I.,__-_..__vv AT ______ ---------------------------•---------- _------------------------ - -----------•--------------- -------------------------- d ----------- ------------- ----------------- -------- =L - - ---- ---- ---- -- ------------------------------------ ---==- --------- ------------------ ---------- --- --- - ------------------------- ----------------- ------------- �FINAL�INSPECTION. --- '- - - Date, _ ,5: 1 ` _ SAN JOAQUIN LOCA. HEALTH DISTRICT 130 South American Stre t 4 300 West Oak S�ree � t I H2-Sca more Street �`� '"" }"'�"""' Y - 814 North "C" Street Stockton, California 7 Lodi, California Manteca, California Tracy, California ES-9-2 M , Revised 1-57 ET.CO. - e