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„ Y PPLICATION FO ANITATION PERMIT Permit No. _• A l� (Complete in Duplicate) Date Issued ._..-��-��- (� \ This Permit Expire; 1 Year From Date Issued Application is hereby made to the'San Joaquin Local Health Dice strict f o a permit to construct and install the work herein described. This application is made in•,compliance with County Or 0 2: North__Childr�_ss.�_..�tackton_�---CaliP.----------------------•---•------.. JOB ADDRESS AND LOCATION. 1_..3-_.�.... Phone.---Cr.. Owner's,Name...... OTI_-RTld_ mflri. .............................................. --•---•-•------•-----------•--------------- Childrees Lane -- 5tk°n.__•- ........--- . 10 .2 N. Phone -Ho. Address__.---------•------•---�---�....---•---------•--•---•-----------•------ Delta...�el?tig_..Tank-----erviCe_�__:I-ne_.,,..--..............................Motel Other p Contractor's Name_......_.___.__.._._. Installation will serve: Residence ( Apartment House ❑ Commercial p Trailer Court ❑ 1•-aC ._•-•.................................. Number of living units-. A... Number of bedrooms_.3... Number of baths .__. a Table sizeble 3.�-•ft- Water Supply: Public system C1Commurii stem E] Private aDepth to Water a _ty system Sand Loam❑ Clay Loam❑ Clay❑ Adobe® Hardpan❑ , Ohara of soil to a depth of 3 feet: Sand'o Gravel❑ Y No A Application Made: Yes ❑ No ® New Construction: Yes EX No ❑ FHA/VA-Ye s❑ ; Previous App' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet-) Liquid depth--------------- ------Capacity_.-. Septic Tank: Distance from nearest well----...........•-Distance from foundatioq___...------•-----Material.------------••-------- ------------ Ex ting No. of compartments.. Size Distance to nearest lot line---------------_ t Disposal Field: Distance from nearest well....:............Dstance from foundation.................... Eating . Number of lines-----------------------------------Length of each 4ine._._.-...._.---••- ••-----..Width of trench...--•---._•.,••-•• LDepth of filter material-----------------------Total length.............. Type of filter materia(...........:. POCk .De th.ld-------- Seepage Pit: Distance to nearest wall a-i_.._....Distance from foundation._._1 s-•,-_...Distance to nearest Ioline...............•- 1 �....---_Linin material_.............---_----Size: Diameter... 3.............. p Number of its.._....----.. 9 ��. Distance from nearest well-_.-....._......_.Distance from foundation._...__..•--•• Lining material......................•-------• Liquid Ca aci gnls.� Cesspool: p ❑ Size: Diameter--•--•------••---•-....----.- DePfih_-------------- ---------- ----------------• .........Distance from nearest building-...-. ---------------------- ----------- Distance --------- Distance from nearest well........ -....... f Privy: ------•-•-••--------------•-•----••--- - ❑ Distance to nearest lot lino_...._...__•-----••--•- g 8t81II @ to existin Remodeling and/or repairing (describe):-----�a�ng-_22eW..---.��tLT'.---•---------------•---------------•---• ------ -•-•-•-••-•-..... ...... ............••._....._... done ----•--•- •------•---------- I hereby certifyhat I have prepared this a! Pof the San Joaquin Local kHealth @Distr District. accordance with San Joaquin County ordinances, State laws, and rules and regulations (Owner and/or Contractor) (Signed) fll --. QRYr .._...`.f'. 1�._.'y X'!ir1C.�-s...lwq-c......------ -------------- ------------ ........ ........ {Title)_.-........°.... ...................._....- Gen in relation to wells, buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system FOR DEPARTMENT USE ONLY —/G--6..p ..... DATE-----max-...--•--.... ---- --�_.'-- ------------------------------- DATE.. -----------------------. -.. APPLICATION ACCEPTED BYf_ta- ..•�-�-•�,•�'�••- -_••-.__•__•__--...-._. ----------•------- -------- ..... ..........:................•-••...._...........-...- --•------ REVIEWED, BY.---....-•---•-•--••-- - .._.__.._.............•-- DATE.........------------------------------------- BUILDING ----•--•---••---••-•• BUILDING PERMIT ISSUED.............................------------ ---...---...._....- �:.......-••---•-----•................................. Alterations and/or recommendations:.-----..• ,...... /(f -•C.:_..... ....... ....._... ................. . ---............_ .............................. .. .................................................... Date......_.- -... ., _.... FINAL INSPECTION BY;.i�r-.;•• ......... SAN JOAQUIN LOCAL HEALTH DISTRICT 814 Nor+h "C'• Streat 300 Wast Oak Street 132 Sycamore Streot Tracy. California 130 South American Street Lodi California Manteca, California Stockton, California ` X5.9-2M Revised 8-'59 F.P-Cc.