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FOR OFFICE USE:' <br /> -------------------------------- <br />--------- -------------------------- ------------- <br /> APPLICATION FOR�SA ATION PERMIT Permit No. . �-- y <br />' ...-=---- ---------------------------,---. (Carnplet�;pin Duplicate) <br /> This; Permit Expires i Year From Date Issued Date Issuedl-�er�� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND CATION-- Zl <br /> Owner's Name--------- _' _ Poe --------- <br /> ,�ii ---- <br /> k� •_' Y <br /> Contractor's Name------ :.. --- -------��' -------------•------ Phone................. '.------------•- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑.W0I AV <br /> ' <br /> Number of <br /> living <br /> units: Number fbed ms Number e h <br /> ' ` <br /> Water Supply: Publics stem Community system [I PriateDpthto Water Table5_Aaft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob?A. Hardpan ❑ <br /> Previous Application Made: (If yes,date__..._.__.._ __ ) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sep c Tank: Distance from nearest well Distance from foundation �_-Mater l ------!��''h <br /> ' -- <br /> No. of compartments-.--_- .._Size- 1aLiqu�d d�th °__.- --------Cdpauty._ f � <br /> Disposal Field: Distance from nearest well �- --Distance from foundation _ ...Distance to nearest lot line <br /> Number of lines._ ___ _ _f Length of each line ___ Width of trench_ ' ell <br /> '. _. g �� --------------- <br /> Type of filter material_ Depth of filter material__ _- ..Total length.... ' -- ----- - <br /> Number of "p ts._. Linrng material__ �ndation Distan e o nearest lot line <br /> Seepage Pit: Distance to nearest welf.. Distance fr m fo Size: biometer <br /> -Depth �s� <br /> 1CeSS 001: t+�wa• u� fStdnCFffrom.nearest.we&_ 1-,% « Distance-4 roI ounddfJ6}0ktl lt," *t#L:.,LIn1nC�'md Brldl ^"*._ �'" +r'`---..-.. . <br /> } <br /> .. Liquid Capacity --- ---------gals. <br /> Size: Diameter. .. _ ----------------Depth---------- ------ ---------❑ �. <br /> Privy: Distance from nearest well-.-- ' : �:.a DistanZ` Arrom nearest building <br /> .' ..: r .' - r•n'i mar..�k_-----ate,.,- ------------------ <br /> -------------• �ir� `riSsE 7k a-w. ad.�,,..•a.�.�a ad�+°*w� _- <br /> Dista'nCe•tn•nearest lot me .�. , ° <br /> -- <br /> Remldeling and/or repairing (describe) ----- ------------ -------- -------------------------- ---------------------------- <br /> ------------------------- <br /> -- ----------------------- <br /> r ----------------------- ------_--------- - - -- ----- -- -------------------- <br /> �.: r - <br /> • r <br /> 1 <br /> hereb certify that I have ,prepared this applice" <br /> ion and Ith t_ot.hei'work will be done in accordance with San Joaquin County 1 <br /> A. <br /> .,or laws,:and rules and.Yegulations of the San Joaquin Local Health District., <br /> Q _'�1 <br /> {Slgnt! --- r --- - -- e— _ -------- - -- w and/ Contractor) <br /> 1 <br /> B " . G Title_ sz <br /> Y:--- = { <br /> (Plot plan, showing size of,lot,r cation of stem in relation to ellAys, buil" trigs, etc., 'can I e ced on reverse side). F <br /> ....-'._,,,.:.�. FO{t,DEPARTMtlNY-USE,GNLY.--, <br /> aAPPLICATION ACCEPTED i3 ------------------7---- DATE------�� 7=(o�---------- ------------- -- <br /> REVIEWEDBY --------------------------------- -------- - --------- ----------- ----------- --- ----- DATE------- ------------- ------------------------------------- <br /> BUILDING <br /> -----------------------•----•-------BUILDING PEd ISSUED-------- - ---- ------ ------------------------ --L.i*•�w�%�u�.-.-.�-e.-.-- -------- DATE„- <br /> ----.-.-r.m-.r-t-+-.- ---1Alteraitions and/or recommendations:___. - "+ -------------, <br /> r - - <br /> - <br /> k <br /> r ----- <br /> --- ------------------- --- ......... - ------------------------------ <br /> --------- -- -- ----- - ------- ------ -- - ------" ----------- ---------- ---- -------------------- ------------.......... <br /> , <br /> - <br /> : _ <br /> FI'N ',L INSPECTION' BY...-- - '. .._. ._._.- -- ---- -- ._--- Date-- - --- ----------- -------- <br /> ..sn-y..s•�.t y. r'�{.g..>a...:yew...-....•..� '�...,cr�+..,a�a.L,-' -+f+•r --y»....�' :r r.-.>' r. -. „H:ra.o•v..K.��.y....,•,•s�.;•:�w.F„x..,..a„eiM.�•�—®•at.-u�w,..•�sr�...iv.«;� r <br /> S,�IN JOAQUIN*LOCAL HEALTH DISTRICT t <br /> ,. n ,>+ w.. w{ wrv`rr.+4 nti Lb4 <br /> 1601 E.Ha:elton Ave. 30 1 ,1 t oak Street 124 Sycamore Street, 205 West 9Th Street <br /> Stockton,'California` Codi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />