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FOR OFFICE USE: ------------- -- --------------------------------- n --------------------------------------------------------- APPLICATION F6k_ S NITATION PERMIT Permit No. __�-1�-'1-?--�---- ----------------- ------- ----- ---- -------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LOCATION__/zal.ow- 411z--- _ -- ------- -`� " e.' Owner's Name------ a =� '-[---•------ • ----------- Phone------------------------------------ Address-----------•-----....... - -- Contractor's Nam - --------------- -------------------------------..------------------------------------------------------------------------------------ Phone------------------------- Installation will serve: Residence 1p Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J----- Number of bedrooms ---3-- Number of baths '_. Lot size ------�f_'_'�__ '_r__x_�"______________________ Water Supply: Public system E] Community system ❑ Private, ] Depth to Water Table Y. ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ? Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------._I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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-------- ------Distance from foundation--------------------Material____---_-_____-__---__.________________-__.____. ❑ No. of compartments--------•-----------------Size--------------------------------Liquid depth---------------- ---------Capacity-------- -------- Disposal Field: Distance from nearest well .......Distance from foundation..f_A-_______.Distance to nearest lot line__,___.________ Number of lines_______ __ ____ _____ __Length of each line----�_P_-____-y-------- Width of french.___��' _ ______________-_.--- Type of filter materia_ --------------- Depth of filter material---1_?---- __.____Total length____ ---------------------------- Seepage -___-__-__ ________________Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--.__.__-______._ ❑ Number of pits----------------------Lining material----------.------------Size: Diameter---------------._.-----Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-__.____---_--------_______________- Size: Diameter----------- --------------------Depth----------------------- ----.----------__._Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________ _________________ t-----------Distance from nearest building___-----__.__________________________.._. ❑ Distance to nearest lot line -------------------------------------------------------------- ---------------- ------------------------------------------------- r Remodeling and/or repairing (describel: -.... --- --- ---------- -' ----- --------------------------------- -------------------- f ---------------------------------------------------------------------•----•------------------------------------------------•-•------------------------------------------------------------------------------------------------ ---- ------------------- ------------ ------------------ ----------------------------------------•--------------------------------------------------------------------------------------------------- -------- ------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----eswinag ------------------ - -------------------------------------------------------------------------------------------(Owner and/or Contractor) gy:- --------------------•-- -- ----- ----------------------- ---------------------------------------------(Title)---------------- ---------- (Plot plan, size of lot, location of sys m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED13Y -- ------------------------------------------------- DATE---- --- --- ---- REVIEWEDBY------------------------------------ ---------------------------------- ------------•--------------------------------------- DATE----------------- BUILDING PERMIT ISSUED---------------------------------------- ----------------------------------------------------------- DATE--------------------------------------- ---------- Alterations and/or recommendations-------- ----------------------------------•-----------•-"-""--"------------------------------------------------------•-----------•---------------•----------- -•------------------------------------------------------------------- ----------------------------------------------------------------------------•------ --•------- --------------------------•------------------- ------------------------------------------------------------------------- - - --- - - ---------------------------------------------------------------•----------------------------------------------------------------------- FINAL INSPECTION BYe�_ __ ------------------------------- Date....f-%, _rj__,63 ----------------------------------------------- SAN - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 3M 3-'63 F.P.CO. 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