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FOR OFFICE USE: ------------ ----------------�;�r �-- " APPLICATION FOR, -A�NITATION PERMIT permit No. .12"_ (Complete-in Duplicate) Date Issued .._. _.- �J ------------ ----------- -- ------------------------ YThis Permit Expires 1 Year. From Date Issued p / 270-/Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication.is:made in:complian e;with County Ordinance No. 549._ F ti JOB ADDRESS AND.. LOCATIO - �.----.! :°I - `.�------ --- -------- - 1 -V . .... - - ..........J ---------------------------------- Phone. f;------ -------------------- Owner's Name------------ ---..-pp-�� - r ' Address ... , �_ =x`•� '% l�f= " , �.�_--- -- -------------,��-------- i, \ ---------------- Phone------... ------------- ---- t6 r.- Contractor's Name------ ..��--------•-••----------- '----------------------------- '-'---- �� ------ ---------------------� ❑ ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel Other 1 �# I Number of living units:... Number of bedrooms __.- Number of baths -.- Lot size_._!? ------------------ Water Supply: Public system geCommunify system ❑ Private ❑ Depth to WaterfTable ft Character of soil to a depth of 3 feetT Sand Gravel ElSandy Loam E] Clay Loam E] Clay-[]A Adobe [] Hardpan El! Previous Application Made: (If yes, ate ..... .:... .... No New Construction: Yes' Ngo ❑ t�1 �A/VA: Yes �f? No • d 1 TYPE OF.I_NSTALLATION-AND SP_ECIFICAT.IO.NS.-=- - - - T(No septic tank or cesspool permitted if public sewer is available:withi�2037o,-;7. t`_i),.,- Se T1ptic T nk: Distance from Weare t well y Dis#an e frori fouFndatio .... .Material `' ` +~1 P �" --- Size.. _ � Li ui e th 5' ....Capacity! _t-- No. of compartments. ... f - ..0.....- Distance to nearest lot. .� S 1 ` a p• Disposal Field: Distance from nearest well.-. ._-Disfiance from foundation Width of ranch-_-_ linea_-.-_-------- IJ , Number of lines------------ -_/-. ..Length of each line.- -- -- �! Total len th.. ._ - i l Pit: Distance to nearest well_ -��.�� Depth of filter material �'�. _._ ._ g, . . ... ----- -•.---- Type of filter material t Seepage I ---...-..Distance from foundatioa �__._..-. Distance'#o heart lot line___..............s._+ ~ [] Number of pjts--- ----.-_.- - ...Lining material---------------$�'JSize: Diameter--- ------------ --------Depth--- ------------------ Cesspool: Distance from near"est well ....._--....._-Distance from foundat,ion---- ..............Lining material__._------------------------- ❑ Size: Dia�meter ------.Depth--------------- ='= Liquid_ apa6,fy_ .---------- ------- -gals I Privy: istance from nearest well-------------------------------------------------Distance from nearest building-------------------------------_----- ❑ Distance to nearest lot line........ ~`-�--- --------------------------------------------------- ------------------ - = ; a L j Remodeling and/or repairing describe --------i-OMl�n .FRQDO-------74Kf- -------- -S -, _ ..1�c7 c1 J�_�- /�,_ ---._�H�t� 1._T� per..- N-Kn� ----------------- - 1m--`Tt1l ' ' `A �� - ---------------------------------------------- --------------------- - -----------------'}------------- ----- --- _--- -' ' I I hereby certify that I have prepared Ai -application and that +he w—dAr will-Ke done in acZ6—rdance with San JoaquinXount_,� ordinances, State laws,.and rules and regulations of the San Joaquin Local',Health District.l= } � (Title) s -E -{ ww (Sign= F 'fr o h-. anoron --(Tit e)---------- ------------------------------------------------------------------- ------ I�_(Plot plan, showing size of lot, location of syst6m in relation to wells, buildings, etc., can be placed on reverse side). tl tl } E } y w FOR"DEPiARTivlENT'l1SE ONLY, ! t TION ACCEPTED Y_ �- ::.. - - DATE ; �I REVIEWED BY.-' - _ 1. 8 V A-- ------------------------>= '� ) E rDATE� �" � ----'-�- ' ' ' BUILDING PERMIT ISSUED. ------- - ----------- ------ ---- -------- ----'- -- -----DATE i R -------------- -------------------------------------- ------------------- --- _----- Alterations and/or recommendations:.___-.:_'--�---c.�---:.. --_-_�..-. --- t ( 1 k * : { r � tl V..........------------------------.__.------ ...--------------_---_-------------------- ------• .......---------- _..------------- ................-...... --- -..................... ......... ----------- ------ -- -- - ---------------- ----Date.... -FINAL INSPEC SAN JOAQUIN LOCAL HEALTH DISTRICT � lr 1 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street i 205 West 911 Street i ' + Stockton,California Lodi,California w„- .- ".w Manteca,California Tracy,California ✓/ E.H.9 2M 1.67 Vanguard Press I