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FOR OFFICE USE: • -------------- -- Permit No. ...... f. �� I ------------------------------------------------- ______ APPLICATION FOR S. -t —4 I -1 :a V A ------------------------ ------------------ [Complete in Duplicate Date Issued .""�'�!"!- -•- / { --_-- --_--- ----------------- This Permit Expires 1 Year From Date Issued A, %VAgiM ation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T application is made in compliance with County Ordinance No. 549. fl MA.�T--cf JOB ADDRESS AND LOi.C!ATION.&k-r �"D "_-"-- "-- _ {' •-_111 _- 1-u�? 1�. _ ----------------------------;; ----- Owners Name--:---4°V ------ ...-- ---- ---- -"'" "" u--------• --•------- Address_... J�.:L 5�_[1.L/ �Y-- 5 - ------------- Cont 1 ctor's Name---------0-W M-P --•--_--------•------=-------- .. Phone. O ..... Installation will serve: Residence Apartment House El Commercial [ITrailerTeourt [I Motel ❑ Other [:1Ins size ---".". C-- F- 7-- t---------------- Number of living units: " -" Number of bedrooms _ _ "'" Commtiriit system ❑ Pri ate be�epthhto,Waterri �� Water Supply: Public system ❑ Y Y Table `?- f+.' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ �J" -FHA/V9."Yes:: Na Previous A lication Made: (If. es,date_-""" -. 1 No New Construction: Yesi b N , , _ ❑ ;; TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic.,tank or cesspool permitted if public sewer is available within 200 feet.] ..' Septic T nlc: Distance from nearest well"" .-_"Distance from foundation.--_ © Matetial_ E - - ----- X No. of compartments---- ---- .�-�'-----Size- 9 p. p tY `� ' � Li uid de th . ----- Ca aci I K i Dis os Distance from foundation to nearest lot line--` :"t S` p I Field: Distance from nearest well...---"-_ - 2-�}l.r� ----Length of each line• ---y6 --Width of trench-- `------ .----- : t Number of line ------ 9 ------------ Total length.._-"". ---.--- -�/- Type of filter matenal.""" "__�G __"Depth of filter material __"_ Seepa e Pit: Distance to nearest well---_-_---- ------_Distance from foundation--_---_--_--" Distaancnc to nearest lot line-------------- Number of pits------------- ------Lining material-----------------------Size: Diameter-- Depfh".g-------- ----"--------------- El Cessp ol: Distance from nearest 'well-"""__ Distance from foundation-- Lining materia------4M------- ------ € ❑ De th_.- Liquid Capacity ---...gals. Size: Diameter---------------------- p Privy: ---------- Distance from .nearest well--------------------- ` �----------------Distance from nearest building! s_"". :----=`=---------.----- _-.. _ " ., ❑ -------------- Distance to nearest lot line e" -------•------------=---------------•---------------------------------------•------• -----=•---------• Remodelingand/or repairing (describe}: ------------------------------------- �- t--------- -----------=---- ----------------•-- --- 1 11 fl* = - - y - p p -•---pP------------ ----.---:-----------------------" `- ----------t#.,. --------- - I hereb certifythat I have �e ared 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. L,J --- ------------ — -- — t,::r(Signed�-==-. �=-;`�--fes" - - -- ---- ---: r """ �,'_ _ {Ownera d/or Contractor] A.... . Y: = - -----=---------------------- (Title)--- :: ` '° ----------------------------------------------- placed Y, A; .+ rte^-•� �. (Plot pl�n, showing size of lot, location of system in relation to wells, building s.:4tc', can be placed on revelse stile}. f FOR DEPARTMENT USE ONLY; ., 1 APPLICATION ACCEPTED BY----:---- ' " ----------------------------"----------- DATE---- -- ----l---- 6,1------------------------- '` ' ---------- DATE-----------=' ..-------'.------:_...'- --_----------- REVIEWED BY----------------- -------------------------- -•-------------- 11 BUILDI G PERMIT ISSUED--------------------}------- =-------- - DATE------------------------------ ----------------- --------- Altera+ons and/or recommendations:__AI-' r-RI----- DAf - `K ' -- ------------------ �' Q.INIv pa�f 04cf``: - � --•----•---"-----------------------------------=-----------•------ 1 --------- ---------------- ------ ---------------------------------------•-•--- _ I ---------------------------------------------------- ------------------------i ! t ._ :Date :: � FINAL INSP ON BY: ------------ 1�r SAN JOAQUIN .LOCAL HEALTH DISTRICT r 1.30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street # Tracy,California Stockton,California Lodi,California Manteca,California - es-s rr�vieso a-ss r.P.co.aM 6.60 f :