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FOR OFFICE USE: 7---- ---------- -------------------------------------------- ----- JIJ ATION PERMIT Permit No. ;2 APPLICATION FOR 'SANIT - ------------------------------------------ (Complete in Duplicate) ------------------- -- -------------------- ---- ---- This Permit Ex-pLires I Year From Date Issued 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. JOB ADDRESS AND LOCAT ,TN --- ------Of 1-�1012----------------------------------------------- ------------------------------------------------- ------------------------------------------- ---- ------- Owner's Name_------ ----------------------------------- Phone------Address---------- Contractor's ddress----------- Contractor's Name---------. ..4_9.0F/_;!W-- ----------------------------------------------------------------------------- Phone---------------------------------- [nstallation will serve: Residence E] Apartment House E] ' - Commercial 0 Other railer Court E] Motel Ej-' E] A- ae t Number of living units:'___ Number of bedrooms .'-- Number of baths _�e_ Lot size #� [Community ----------------------- Water Supply: Public system system E] Private [] Depth to Water Table4a ft. Character of soil to a depth of 3 feet: Sand [] Gravel 0 Sandy Loam 0 Clay Loam'[:] Clay E] Adobe g?"H'ardpan E] Previous Application Made: (if yes,date_--.--_ _----) No 24- New 'Construction: Yes Rjelfqo 0 FHA/VA: Yes ❑ No 9 — 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_-_ern-------Distance f.9m foul dation-_/V------ M a:tg ri�I No. of compartments---A------------- - --- depth-- -" Z-- ------------CapacityZ_Z_�----- Disposal Field: Distance from nearest well-----—_ Distance from foundation. Z---0---------Distance to nearest lot line__47__1'__. Number of _-Z -Length of each --------------- Width of trer�ch_21_e------.1�------------------- Type of filter materia --__.__------------------- --Depth of filter material----le��-----Total length__- -------- Seepage Pit: Distance to nearest well--------...........Distance from fou pdation---—------ Distaose to nearest lot line-4 Number of pits---,2-------------Lining material---�_eVA0;4_.Size: Diameter-, - -*..........Depfh,'Ur!� Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material____________________ ~ ❑ aterial------------------------------El Size: Diameter--------------------------- -- -------Depth---- ---------------------- ----- ---- -----Liquid Capacity- --------------------------gals. Privy: Distance from nearest well---------------------------------- -------------Disfance from nearest building______--_.____-__---_____Distance to nearest lot line------------------------------- ----------------------------------------- Remodeling and/or repairing (des.cri be):------- ------------••----------- •------------•---------------------1 11 1--------------------------------------------------------------r---------------------------------------- ------------------------------------------- --------- ------------------------------------------- ------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------I--------------I------------------------------------------------- ----------------------------------------- -------------------------------------------------------------------- I here6y certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------- --- --- -- .... ... (00111=32ZI�!Dr Contractor) By:--------------------------------------------- 4�o_,_(4� e ------------- ---------- ........ -{Plot ---------- plan, showing size of lot, locatiA of system in ion to wells, 6uildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY AP' y - PLICATION ACCEPTED B --------------- --- ------------- DATE-- B -------- RE-VIEWED BY--------------------------------------------- -------- --------------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------- ---------------------------------------------------------------------- DATE----- Alterations and/or recommendations:-_ -----------1_f_3--cA------------------------------------------- ------ -------------- ----------------- -------------------------------------------------------------------------I---------- ------------------------------------------------------------------------I-----------------------------------------------------------I---- --------------------------------------------------- f--------- ------------------------------------------------------------------------------------------------------------_------------------------------------- I --------------------- ----------------------------------------------- --------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------ -- -------------------- I---------------- ---- ------------------------- -------------------------------- ---------------------------- ---------------------------------------- ------- FINAL INSPECTION BY:-'--/ -(- D 7---.---- --- ------------------ -)-- ------------ ate-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street p Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3`63 F.P.0O3