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��IIjATION PERMIT Permit No. , --..:.. 1� APPLICATION- F6 .__ / (Complete in Duplicate) pate.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 LOCATION-- ---- - ------------------------- --------------- Owner's Name----------a------- -----------------iT ----- t� E. _Alp#,ne-------------------------------------- Address--------------------- ---------- D8_114_ Phone.A0. ____3-X7-27---- Contractor's Name-----`----•----•-------- - - ---- - ------------------------ --------------------------------------------------------- Installation will serve: Residence KI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ 7N0� umber of bedrooms __.3_- Number of baths _�---- Lot size __.-_----� --$--�-- L1----•--------- ------------ Water Supply: Public system [1: Community system ❑ Private F1 Depth to Water Table --t+k1r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes;K] No ❑ FNA/VA: Yes ❑ No QC 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____-____._____.-__.Material______-__________ _.____-_____.--_._________ Ex.i sing No. of compartments--------------------------Size-------=------------------------Liquid depth---------------- ---------Capacity--------- --------•---- Disposal Field: Distance from nearest well--------------__.Distance from foundation-____--___--.____--.Distance to nearest lot line-______-___-___ Extiting Number of lines------------------------ :--- --Length of each line---------------------- Width of french----------------------------------- Type of filter material------------------------Depth of filter material - -----------------------Total length------------------------------------- Seepage Pit: Distance to nearest well_____�1Sple-Distance,from foundation__8Iflp1_�__.Dista"e to nearest lot line___-___i�h- $ Number of pits.!_1----------------Lining material__r_ack-----. -Size: Diameter-------2$�_--------- Depth 3Q---------------------- I1 Cesspool: Distance from nearest well------ -- from foundation.__________________Lining material____-.__________------------- als. --De Depth --------------------------- --------------- ---Liquid Capacity----------------------------g ❑ Size: Diameter'---------------'------ p r_ _ _ -. _ _ . Privy: Distance from nearest well'___-..---____._- ------------------ ------"---Distance from nearest building--_______-___----------------------------- ❑ Distance to nearest lot line----------------------------- --------------------------------------•- --------------•---------- i� e�dd ng a ep g --F- t°----ex�._e_t.i.ng---my-atem---------------------- Remodeling and/or repairing (des.c bel_______________-.____ ' ----------------------------------------------------- -- ------------ --------------------------------- -------- ---- -- --- -- - ------i- wi e wo ordinances,hereby cer laws at I have espandared this application the San Joaquin thLocalkHealltheDistnc}n accordance with San Joaquin County State DE1ta = --------------- (Signed) --__(Owner and/or Contractor) ---------- Title (den. P err Warthan Mgrs -------- By:------------------- ------- --••-... ---J-------------------- ------- ---------------------------------------------- -- --- - ( ] (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 � ----------------- - REVIEWED BY_ = DATE--- ATE._ BUILDING PERMIT ISSUED------------------------- s Alterations an /or recom ndations:_--_--l� _ ./ _ _ �%f `_G�� ._lr'!, '---� - ' L� ��// -------------- - Y / _______________________________________________ __.._._•_______________________ ----------------------------------------------------- ------------- _._____--_---------_----------------- ____ _ _______________________ FINAL INSPECTION BY9- , - Date---,E>__ /-- - -------------------------------------------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E5-9-2M Revised 1.57 f,P.CO.