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NITATION PERMIT Permit No. APPLICATION FOR SA / (Complete in Duplicate) 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. f s f t JOB ADDRESS AND LOCATION___-- -- _-�� _ --- - - `� L�- Phone ...h..•- Owner's Name--- --a+'- -- AS S-. ------- - _ ------------- Address------------------------- ��_�_��-------- -- l Phon __ __-�_.____----- �-r-- -6---------- - ______- _ Contractor's Nerms � � " Other Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Cour} ❑ M I ❑ ❑ Number of living units: _�_ -- Number of bedrooms ___ __ Number of bafihs __�- _. Lot size __ ---�-P_�------f----�">� l e Water Supply: Public system� Community system [IPrivate ❑ Dth to Water Table joft.4- p Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam ❑ Clay Loam ❑ Clay E] Adobe -lardpan [I Yes ❑ —.. Previous Application Made: Yes [1 No New Construction: Yes ElNo''�FHA/VA: No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.] # 1--Z-------. h- --0-- Septic Tank: Distance from nearest vy,�ll_ Distance from found tin__. Materialel__-- ___Capacity--. '�►� l � ,' `° squid dep*"--- P Y No. of compartments__. _________Sizes_# __- ---_- Ir- Dispo 1 Field: Distance from nearest well_�li+(lsL.l�--Utstance from foundatio ___ Distance.to nearest lot Iins�_�-�-_---- v Width of trench_-- a --------------- Number of lines----- _----- ---------Length of each line---_-- ---- '--- --- 19`4 __Total length-------------------- Type of filter material �� -------Depth of filter materia____�- _._----- ` t Distancom foundation----&�--�----Distance to nearest lot line Seepage Pit: Distance to nearest well___�(��a.r.�„-- Size: Diameter__. �� p -- Number of pits----I----------------1-ining material-- -- oL'� -- �j--- -- - De th---.cZ�-- ------ Cessool: fJistance from nearest well ion from fiundation___-"______- --__-.Lining material__.----_________--________---_______- p _Liquid Capacity gals. r - ( ❑ Size: Diameter-------- ------- ---.---- -------Depth-- -------- ------------------ ---- -- - --------Distance from nearest building----------------------------- --------- - p , Privy: Distance from nearest well------------------------------------ f`.' Distance to nearestjine-------------------- -------- ------- -------- --- -- --------------- El ---------------- --------------------- Remodeling and/or repairing (describe) --------•------------- -------------------- ------------------------------------ i _- -___- ______________________________ ______-_-__ _________________ __________ _____.- 1 --------------- ________ ______ ___ ______ ________ _ ___________ _--------------------------------------------------------------.----------------------------------------------------------------------------------- _ I here_by___certify__ __ ____ __ that I have p_repared this application and that the work will be done in accordance with San Joaquin County 4 ordinanc to laws, and rules and regulations a San Joaquin Local Health District. 0 -----------------------------—0;4 Contractor] i_ i �} {Signed ----1 `` - -- --- -----(Title)------------------------------------------------------------ ---- (Plot plan, showing size of lot, location of system in relation wells,'buildingS. c., can be plated on reverse si e. --------------------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE------------------- - ------------------ - DATE REVIEWED BY--------------------------------------------- 1 # - DATE----------I-------------------------------------------- BUILDING PERMIT ISSUED---------------------------------- �!_ ------------------------------- Aatio s--and/or ecomer t�ns:_ - �J ~ r t L ti ------------ -------------------------------------------- ----------------------------------------------- + Date----------- 7- -6-Ij FINAL INSPECTION BY___ ___ _______ ____ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 Wast Oak Street y Lodi, California Manteca, California Tracy, California Stockton, California r � f ES-9-2M Revised 1-57 F-P.CO. f