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F R OFFICE USE: �•- r ; _ 63- ------ w --- --- ` *` PF APPLICATIONv, FOR CANITATION PERMIT Perriirt,No. -- -----_-•---.--,---- � ---------------------- --- — (Complete in Duplicate) $� 3 - f Date"'Issued .ill_ This Permit Expires 1 Year From DateNIssued .Application is hereby made to the San Joaquin Local.Health District for a permit to construct and install the work herein-d_escribed. This application is made in compliance with County Ordinance No. ---- - -- =----------------•---•----•-- JOB ADDRESS AN O. 'A ION /,-, - ------ • . -----------•-------------`------------------------- ------------------------ 'Phone----- = = ----------------- Owner's Name.--- - •--•-------'-��------ - -------•-�------------------- , Ile Address_-------------------- � ----=------ -------------------------------------... - ._. ; t ------------------ r l� Contractor's Name--------------- ------ --• -- '=` �'---------------o:7 "-"--�'.....'.-,------ Phone--------------------- -•------- s Installation will serve: Residence ' Apartment House ❑ Commercial ❑ Trailer Court ❑ IMotel ❑ Other ❑ Number of living units: q - Number of bedrooms ;- Number of baths -- Lot seze _ .- •.• ------- Water Supply: Public.system � Community .system F] Private ❑ Depth to Water Tabled Q- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe Hardpan El Previous Application Made: {If yes,date--- �,._. I No El New"Construction: Yes E] No F,HA/VA: Yes E] N0 ❑ _ I ----- - ' TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank ori cesspool permitted if public sewer is available within 200 feet.) e an Distance from nearest well________________Qis#ante from .foundation-__---_----___.__..Material-------------`-._-.----._ ---------------- UQ No. of compartments--------"-.1--------------Size------------------------------Liquid depth---------- --------I---Capacity----------------------- # - is sal Icield: Distance from nearest well_- ------------_Distance from foundation--------------------Dist ance tolnearest lot lirie_-_--_..-----.-_- Number of lines---- ------Length of each line------------------------------Width of french--------------.--------•------------ Type of filter material 11 ---:- epth,of.filter_material------------ ------Total.1 lengths----------••------------------------------ Se epa e Pit: Distance to nearest wel% Dista n om f undation--A---_-_--.Distan e to,nearest lot line- Number of pits-__-_,1-------- Lining material- -Size: Diameter ----------'Depth--••--c ---------------- r Cesspool: �zeaDameter nearest welF_________________Depthce from foundation-__--__--------__L'iquid Capacity___ --------------------------------- El ------_--- - -------------- I t _ -Lining material------ p gals. Privy: Distance from nearest well-------------- -, -::,-__--.---f-------•Distance from nearest building-----------_------------------------------ wpm s • -[� Distance to nearest lot line - -: --_ __ --- :. -- Remodeling a d/or repairjng (describe) -------- -------------- - - -- e - � ---------------------- --------- ------------------------ ----------------•--------- a ------------- I-----------------------------------tt '----------------------- --------- ----- -- -----• - '--------------- - I hereby certify that I have prepared this application and that the work will be done in accordance wt#h San Joaquin County �.. ordinances, Sta a laws, and rules and regulations o.0he San Joaquin Local-Health District. ' Owner ind/!r Contractor------- -------- `=---- - -[Signed) ! R B - - - - ----- ' �'�`' � _(Title[ -- - `- --- Y- [Piot plan, showing size of lot, location of system in relation to wells,hbui ngs, etc., can be placed on reverse side). i € -�, I GR EPARTMENT USE ONLY. . ---------------------- ----- DATE---- P f � ---------- APPLICATION ACCEPTED BY- = REVIEWEDBY------------------------------------------- --- - ----------------------- ----- ---------------- D; ------ g - ----------- BUILDING PERMIT ISSUED----------------------------- _ATE _ t Alterations and/or recommendations:-------.. - tet. - - `"'` f w ^, � w --- _ - - - ..yj_C�.--•._ -� C:_� ------- � k----------._------ , __ ---------------------- --------------------- -----------=------� I �� -- c c re ..�-r-� �x _r-�-- �----- - -------•-- - �-- -- - -��,3----- "'�-.----I` -------------- --- ----- ----- - -------- FINAL INSPECTION BY: 6 t -- _ C' `-�-f---------- ' Date- - =r� ------------------------------ �t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfaseiton Ave. fi 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 3M 3-'63 F.P.CG-