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FO OFFICE USE: — --------� 3`----------- PERMIT7 � - - - --- - =--- ---- - Permit No. _.f....-_�..-•-.-• APPLICATIONFORANITATION t = , ---------------------__/°,-tit--------- ; {Complete in Duplicate) - Date Issued .- -- ' _ -------_------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San iJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance With County Ordinance No. S49. 4 i r --` T /1 ----------- JOB ADDRESS AND LOCATION____--�------------------• = tf �"T --- Phone- ----------=-----•--------------- Owner's Name------ : --------1 -- / ---------------•-----=--....... Address______________ F�,�} � Contractor's Name__-_t__. . 1 _+ t �a~" ------ Phone-- '�� 1� Or .. Installation will serve: ;Residence Apartment House El Commercial ❑ Trailer Court ❑ Motela❑ Other ❑ • Number of living units: 'Number of bedrooms'*';— Number of baths ____L Lot size ----- ----- i .t 7 y - lWater Supply: Public system ElCom_ munify system [-IPrivate . Depth to Water Table ► ,,F y ` Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ San'dy Loam ❑ . Clay Loam ❑ Clay❑, ',AdobeZ] Hardpan ❑ Previous Application Made: f yes,date--------------------1'NNo ® New-Construction:- Yes,[] No FHA/VA: Yes E] No (1"f TYPE OF INSTALLATION AND�SPECIFICATIONS: J� . (No septic tank.or cesspool' ermitted if public sewer is available within 200 feet.) -a 1 �' - —.T- � Septic Tank: Distance from nearest well-""""'�"_"Dis#a rice from foundation--------------------Material________-_ __._.______________.____.____..----. ❑ .No. of compartments.- ::-.fir: .;jsize'=.#.... ---•-- --.Liquid depth---------------- ---------Capacity----------------------- Disposal Field: Distance from nearest well....�L?--_.._.Distance from foundation.____!A-±--..___Distance #o nearest lot line`*., Number of lines--- t----- -------"-----------------Length of each line---:-------�?_.5- ... -----Width of trench-----------`911---------------- P � -------- ,Type of filter material_ G -„--De th.,of~filter material______ _ ______.___-Total' length_____.__-_______7,�_.- € C kP Seepage Pit: Distance to nearest well___.__---"_.__.____iDistance from foundation _._________:.___.Distance to nearest lot line------- ..,a ------Distance from material-___'._______________________________- p ------- ---------Li'� uid Capacity ❑ Size: Diameter�- ------------ ------------- Depth_ --•-------- -'---•------------ � � ------------ ------------gals. i _,___Distance from nearest building__________________________________________ Privy: Distanc9 e from .nearest welL_,ti---------------------------------- ❑ Distance to nearest lot line------------------ -- -------- ° �i .R-�. - -------------------- Remo deling and/or repairing (describe):--------4-D-�--------41�---------- ---------` = 4 ____________________________________________________________.. ------------------------ -•--------------------------------------------- - ------------- -----------------y- heteb cern ---------------- ti y fy 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 Qisfrict. r Contra --'------- - ----------------- ------=---- ------------{ wner and/or `tor) (Signed) �. (Titl) ---- ------- ---- - -------------- e (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 PEI APPLICATION ACCEPTED BY �� ------------- DATE-,..... ---�----�----- ------ --------- ----- REVIEWED BY------------------------ # DATE_ --•-------------------------------------------------------- BUILDING PERMIT ISSUED---=----= DATE------- ----------------------:------------------------------ - ---- - -- - -- - --- Alterations and/or acommendations:----------------- ---------------- . --- ---------------- 19��° Q° ' gyp ;,___ 1 ' ~ � --_ ,------- ----- ----------- = = F =- �. -b`� r . FINAL INSPECTION BY: ' ' Date-- --. ` to JOAQ -LOCACIEALTH QISTRICT / 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California a i E5 9 REV$SEO a-54 3rd 3•'63 f•-P.CC. ��