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FOR OFFICE USE-. ?---------- ------- Permit /6 .5.. APPLICATION F., .NITATION PERMIT No. ---------/ /-------y'----- -----:f !7------ (Complete`in Duplicate) :This Permit Expires 1 Year From Date Issued Date Issued ----_ _I_ Application is hereby made to the San Joaquin Local Healfh'District for a permit to construct and install the work herein described. c This application is made in compliance with County Ordinance No. 549. Kt -----------------------I------ JOB ADDRESS AND LOCATION�___I-:-- ---Z •-••- -- --- - ------``-----• -•- -- ------------ Owner's Name----0 = _.. �' ' `"�' Phone C1 Address......----131Z vx --••-------------------------------------------------------------------------------------------------------- v � ---------------------------- Phone --------.Contractor's Name---------^� _.__ - ---- --------- • - - Installation . will serve: Residence ❑ Apartment House ,❑ Commercial ❑ Trailer Court •✓Motel ❑ Other [] Number of living units: __._.Number of bedrooms,__ Number of baths_ Lot sixe ______________-_.--__._ � Water SPPYu l : Publicf system E] Community system E] Private`�E Depth to Water Table _Z�ft. ~~ . Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe [ rdpan ❑ Previous Application Mader (If yes,date--------------------) No [ New Construction: Yes'[ 'jNo ❑ FHA/VA: Yes ❑ NoIF � TYPE OF INSTALLATION AND SPECIFICATIONS: (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) t IF Septic Tank: Distance from nearest well__. _0!_P-_---Distance from foundation_/O------------ Material-- P+'4 No. of compartments----a---------------Size_"" __a[-- -f__.___Liquid depth------- ... ------------Capacity....2.ff-40.,5' Disposal Field: Distance from nearest well--S o 0_1_Distance from foundation'O_0__ -------Distance to nearest lot line----.S'!___ � Number of lines----------;-----------------Length of each line__ _QQ-_ -------------Width of trench.__ __ ''* # Type of,filter material77/7-0_K------Depth of filter riiaterial-----/?'-s______Total' length-------:4-4F_!_.__.__1----------_.--- Seepage ___ r p ge Pit:-" Distance to nearest well-j-00. _---- Distance from four dation_Z .�___._.-..D• ante to nearest lot line___^�.__ Seea Number of pits--.--- g _ =_._Size: D:ameter____: __ p �- -.-.----.- L� 2 Linin materia[- -_.----.De th------..�,.1`--- - Cesspool: Distance from nearest well.-----------------Distance from foundation--------------------Lining material___.____.______-___.______.______._. ❑ Size: Diameter-------------- -------------------._Depth--------------------- -------------------- --------Liquid Capacity--.-------------------------gals. Distance from t ---__Distance from nearest building € nearest well------ ---'------ - ------------------- 9--------------------�------------------- Privy: Distance to nearest lot line---------------------------=------------------------------------------------------------------------------------------------------ ---------- Remodeling and/or repairing idescribe) ------•_... - -- - ---------------------:__7 -----------------------------:------------------------ ------� - -- ----� -r --------- :------- •- --------�----,-- T -� f�� -"---- ____'-- ' ate - f ------a�'`rl ---�`-Te�t� f -- rZ t' z�.cyz `"r f ----------------- I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County c ordinances. State laws, and rules and regula4emin he n Joaquin Local Health District. (Signed) ---------- = ---------------------(Owner and/or Contractor) BY:-----------------------_--.:.. ------ ------ - (Title) -- (Plot,.plan, showing size -f Iot, location o sylation.to wells, buildings, etc., can be placed on reverse side). ) FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY--.-- ---------- - ---------------------------------- ---- DATE-------yf f ' �..- ---- REVIEWEDBY = -----------------• - DATE-------------------•-------------------------------------- BUILDING PERMIT ISSUED------------ -------- ------------------------------ ------------------------------- DATE------------------ - -- - - ---- ------- - - -------Alterations and/or recommendations:_______ 4 r` �-��- 3- "` = - cam —` —z--.. ---------- ---- ---- - - FINAL INSPECTION BY:-----_.�.�.._.. A ----------------------------- ------ Date / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. '300 West Oak Street. 124 Sycamore Street 205 West 9th Street Slockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 31A 3-'63 F.P.CD. - i1 K