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FUR OFFICE USE: y T -— /D J.. f- ---------------�' .____-_. APPLICATION FOR SA tTAA10N PERMIT Permit'No. --------------------------------------- - ------ (Complete in Duplicate) ------------ -------- �----�-•--- -- �------ --- -This Permit Expires 1 Year From Date Issued Date Issued :0.,17__4,5 j Application is hereby made to the San Joaquin Local Hoalth 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 L _ _-. _ - T _f17 �.� AJ.N�_04_CATION . __ - -- Owner's Na /'J f - � ' Phone--------------------_- I ----- --- --------- Address__. p ---- -- --- �' it !k e Contractor's Name_.J__F_L---_-�_ y.._`'_.!-` _3_C _R ..-__TT__.:.�.VS7+-------•-----------------------=-------- Phone_. Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: -(-____ mber of bedrooms .I Number of baths . .. Z S_ �- - Lot size ----��. - -�•--1---------- �--------------- Community -------- I Water Supply: Public system Community system ❑ _Private ❑ Depth to Water Table -6d ft Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date=.--------- -------J No ❑ New Construction: Yes ❑ No ET-_'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is T c Distance from nearest well_________________Distance from foundation-____ V No. of compartments--------------------- ----Size-----•------------------------Liquid de th----------------- -------- I --. Ca acit os l j,eld: Distance from nearest well-"146"_-Distance from foundation___-----_.Distance to nearest lot line____ �� Number of lines------I--�-t �. --�. ,`_- - - ___--Length of each line.. .-�-f----�-+----.W.idth of trench-.�i�rC-----------�---•-- -.,fi ----------- Naz of filter material Or-�_4_'kk"-Depth of filter ma erial------ ------ otal length_____________________5� --------"- S Seepage Pit: Distance to nearest well_VAO-M-e----Distanc rom oundation__ Q _ Distanced o nearest lot line------ i Number of pits----1______----------Lining material--- -O"d.____.Size: Depth__- ".S' __ Cesspool: Distance from nearest well__________________Distance f t lAundation-..-----------------Lining material_.---..__-____-_....___. ---______-_. ❑ Size: Diameter------- --------- ----- ---.Dept h --------------------------------- ----- ------Liquid Capacity -----------------------gals. , Privy: Distance from nearest well-"---------------_____-__ __ --- - -_ -- :k_Distance from nearest building.__.----_..__________.----__- # ----------- ❑ Distance to nearest lot line = ':__.:_- ---- ---------------- ------------------ ------------------------' ----- Remodeling and/or repairing (describe------------------------ - _ __ ' --------------------•------------------------------ _ -- ---111 -------- - ---------- ----------------- ------------------- -------------- ---------------- --- ----- - ------- --- „� .. ----------------------------------------------------- -----------•--------- ------- ----- --------- ------------ ---------------------------------------- -------- I hereby certify that�.Jjave prepared this application and that the work' 11 be done in accordance with San Joaquin'CountyR. ordinances, State laws, a les and regulations of the San`) quin Local Healfh District. (Signed)--------s>=PT`tt�.--T1s NK-4kRVICE-------------------------- --- -- ---- ----- - - -------------------=�------ Contractor) 2915 E.Miner Ave., - HO 6-3841' {Title-------------------- (Plot plan, showing size of lot, location of system in relatio o wells, buildings, c.;, can be placed on reverse side). FOR DEPARTMENT USE ONLY ) I APPLICATION ACCEPTED BY------ -----CC-- ' ----------------------- ---- - --------.--._ DATE----- f ' - = 1 -- - ------------------------ REVIEWEDBY ------ -- ------------------ ------ --------------------------------------- DATE BUILDINGPERMIT ISSUED------------- ----------------------------- ---------------------------------------------------- DATE----------------- --------. Alterations and/or recomm d tions:-------- ----- -- -- ---- -------- - - -- --------- ------- -� -6T ---------------------------------- - . w _ _ _ FINAL INSPECTION BY: ------------ -- -------------------------- Date_ ---i-------- SAN JOAQU.IN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.C C. i •