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FOR,OFFICE USE:r .: w ' ----- - -- APPLICATION FOk SAIITATIO ----------------- N PERMIT Permit No. rQQ�_ -----------AIA----------- - --- (Complete in Duplicate) + Date Issued __ __- This Permit Expires 1 Year From Date Issued .. Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfali the work herein described. This application is made in comp iance with County Ordinance No. 549: ZZ7�3ciO rt�2— SC'Y JOB ADDRESS AND L TION.__-0_ _�' _J �.�- ----/4�C ------ IT..- ,�C-- -------- I '�J ---------�Z�__.----- Owner's Name " _ f Address--------------'.... _ ...- Q ---._..lQ " SLQ ---------------------------------------------------------- Contractor's Name.--------Q-IAEA-F— ------•--•----------•---- ------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence E�—,.Aparfinent House ❑ Commercial .❑ Trailer Court ❑ Motel [) Other ❑ Number of living units: t------ Number of bedrooms-____ Number of baths _ Lot size ___ _ - }C7_______________________ Water Supply: Public system E] Community system ❑ Private �/Depth t,iWater Table 25'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑y Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: [If yes,date-----------------...] No [ New Construction: Yes ❑- No'2T�-FHA/VA: Yes ❑ No'�� A. : -TYPE OF"INSTALLATION-AND:SPECIFICATIONS:` :..... ..a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4Se tic Tank: Distance from nearest well___________Distance from foundation___'1_�D_______-M ter'al_:CQ/V_CR ETJ _-.-------. D �KOND No. of compartments. '2-_______________Size X_�X. _.___Li Liquid de th_-- Z—._---.-Ce aci p q P. p tY -•S !,-Disposal Field: Distance from nearest we11 _ '._Distance from foundation_. Q_ __. .___� __ Distance to nearest lot line---- E F Tmf&- Number�.of cines__________________ ___..&.____Aength of each line__.3Q_- 1-30--- 'L . _ Width of trench.------2T-�`---'----'-----_-- DD Type of filter maferial.__kQC-K,' Depth of filter material_'__!____.___._Total.'length--------------6-0__---____._________ °C+ r Seep�a,ggee Pit: Distance to nearest well----jj_p - Distance from undation____!0_::______. istance to nearest lot line__.___________ Imo" ---- i�11 �� _ 'Number.of pifs----- ------------ Lining maferial--9 Dia meter_L):� '-- --Depth-_---------)_�_!----------- Cesspool: Distance from nearest well-__--------------Distance from foundation______----------------Lining material__.-----____-_.____.____..__________-. ❑ Size: Diameter------------------------ Depth----------------------------------------------------Liquid Capacity------------------------- -gals. i - Privy: Distance from nearest well_----------------------------_______'.__._.___.__Distance from nearest building---------- -----------__________.____.- ❑ Distance=to nearest lot line '-'- -------------------------------------------- Remodeling and/or repairing (describe) -____...._ -----n+ ------------------------ :. - ---------------------------------------------------------------------------------------------•---------------------------------------- f I hereby certify that I have prepared this eppiicafion and that-the work'will'be done in accordance with:San Joaquin County ordinances ate laws, and rules and regul tions of the San Joaquin Local Health District. - — (Signed)--o --- _:_- , --.---- (Ownerr and/or Contractor) By:-----------------i---------•--------------------------------------------- --------------------------------------------------------(Title)---------------------------------------------:�-. - -----� (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). + i FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY---'- ` -. - - -------------------------------- DATE----- - ----��-�----'------ - - - REVIEWEDBY---------------------$------------------- ------ ---------------•----------------------------------------------------------• DATE------- ----------------------------•-•--- --------------- BUILDING PERMIT ISSUED--- 4e;--o-77.-6G - --6'i�A!i...., XCA*4TAE_>- DATE Alterations and/or recommendations:_-_ -"[`- - +- ------------------------- t -------------------------------------------------------------------• -- ------------------------ ----------------------------------------------------...-------------------------•--------------•--------------- 'i . ------ - --•-------- FINAL INSPECTION ..-' ...... -- --- - - t -- Date---- '-'---'--?�--.�L__ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California - Lodi,California _ _ Manteca,California Tracy,California F.P.Cu.