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FOR OFFICE USE: � 3dR�Nd -------_------ ----- --_--.` v APPLICATION FOiTATION PERMIT Permit No. _�'........:...... ------------------------- ----- (Complete-in Duplicate) � G, °• Date Issued .�--------�%-------- -- ------------------ ........ This -- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. � r r � JOB ADDRESS AND LOCATION----- te*___ ------.. ' nC5 ' ---------- ---- -- - -- I -Owner s Name Cean G1 --- Phone.,[3 '-/3 ----------- , 'Address______--�`S�"' I \ (� eiC�1 -'----------------_rl -- ---- -----.��n-.E- ---- er yr C C_ Contractors Name---- P-� Phone-._--.-_- --..- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: V--- Number of bedrooms .3---- Number of baths j��- Lot size joox/6.v- ------- ------------------------ Water Supply: Public -system,E] Community system Private-❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ili yes,date_.-_%.9bU.- } �No ❑ ryNew Construction: Yes ❑ No d FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 240 feet.) Xis Septic n�C:'S Distance from nearest well.................Distance from foundation------------------ Matena4 ------- -------._.------------------------------ No. of compartments---------- ---------------Size------------------- =-----Liquid depth.-------- ------ ------ Capacity------_-------------- I Gp r s Dis osal Fie : Distance from nearest well.................Distance from foundation.___________.._..._Distance to nearest lot line-------.--------- Number of lines----------------------------------Length of each line-- ---------------------------Width of trench----.------------------------------ ' fa�� Type of filter material-------------- Depth of filter material-----------------------Total length_.-.-_.....-----..--__---_.---________ V ttCr I Y _ �� Ice-a r ; Seepage Pit: Distance to nearest well-�____'Disfance from foundation__,!o____________Dista�Distance to nearest lot 1i e-- ----------- ❑ Number of pits.". �-_! � g c._.Linin material * 9 Size: Dia mefer__33__.__...---.Depth-&;,Z _____________________ I , n Cesspool: Distance from nearest weld ----------------Distance from foundation---------------_ ..Lining material-.-....---------_------..-.----_._-- 0 ❑ Size: Diameter- -- -------- ----- ------ ---------Depth------------------ --- --------------Liquid Capacity-------------Y ---------gals. 13) ` Privy: Distance from nearest well---------------------------------------------►.--Distance,f_rom nearest building----.--_--.----_-------__-_-----..--.-_. ❑ Distance to nearest lot line- ------ ---- ------------------ --------- -------------------------------------- ----------------------------- - ----------- 1 r Remodeling and/or repairing (describe):..._.- ----------- 6--------- -•-••-- �fi ----.----- ------ ---------------- -------------------------------------- - ----- -------- -- ---- -------- - ------ ---- - - ------------------------------------------------------------------- --------------------- ------ ------------- ----------------- - 1 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. r " Signedt~ . - -.-- ----..--4- --...-Owner and/or Contractor By:-------------------------------- ---------------------------------=---- ----- Tt+le k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY - ------------- ------ ------------------------- ---- -------- DATE__..-�e'`3�`��y - -------------------------- REVIEWEDBY.--------- --------- --------------------------------- ------ DATE------ ----------------------- ---------•-- ----------.: BUILDING PERMIT 155UED-- ------ ----------- - ATE A era+ions and/or recommendations:._ �- --_ _,__X �;; .� 3 ' FINAL INSPECTION BY:------ ----------- Date-------------------------------- .- ------------ - - - -------- I I SAN JOAQUIN LOCAL HEALTH DISTRICT 11601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street j Lodi. California Manteca, California Tracy,California Stockton,California E.H.9 2M 1-67 Vanguard Press .-a�„�y, '•" F 1 Fes•. --:;y -