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g� , 4, �A41_ICATION FOR 'NITATION PERMIT J Permit No. i F (Complete in Duplicate) Date Issued ./,(-,----__-----__ Application is hereby made+o`fhe San Joaquin Local Health District for a permit to construct and'instali the work hereindescribed. his application is matte in compliancewith County Ordinan No. 549. .y --• ------------------------ *�JOB ADDRESS'A LOCATION-- - -•------, L-- -- - C�1-�7 ! p --------/---------------------- a Owner's Nameti- --------------------- - - -------------------------------,... Phone-- ` - f� Address------- = T i� ----- Contractor's Contrac+or's Name --------------------------------------------------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel Other ❑ Number of living units: ---J---- Number of bedrooms _ Number of baths __/____ Lot size �� - l Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SaIndy Loam ❑ Clay Loam ❑ Clay p AdobHardpan ❑ Previous Application Made: Yes ❑ No New ConstrucfionF: Yes No ❑ FHA/VA: Yes ❑ No D TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) p ---.________ _Size / o fou idation_/Q-___------.M trial Septic Tank: Noof compartments-_,R artmentst--well---- --- Distance-f rY,�-----_...Liquid depth--- ----_=[..-------Pa acrty.____�Q�--_-- Disposal Field: Distance from nearest well-- -------------_Distance from foundation___________.____-_.Distance tont lot line'.___.___.._-__._. ❑ Number of lines-----------------------------------Length of-each line--------------_---------------Width of french------------------° Type of filter material-------------=-----------Depth of filter material-_--------------:-- __T fal length------------------------iM---------- Seeps e Pit: Distance to nearest well------7 --------Distance"from f ndatio :. Dista ce to nearest tat liner Number of pits--___�______,____- Lining material _ . _.. �� --- Size: Dia eter---. Depth Cesspool: Distance from nearest well-----_-----------Distance from foundation._______ ._.-.___.Lining material------------------- Di❑ . �;� Sizeeameter-- -----_- l4 �. r ;- :.Depth : _----- :, _. --- _ --- --Liquid _Capacifv--------------- ---------gals. > rivy: Distance from nearest well--------------------- ------ __- _____Distance from nearest building________-_______________,_--------_-_-. ❑ Distance to nearest lot line-..__..__ x -Remodeling and/or repairing (describe :----A - ----- - ------_ I ///000 --------------------------•-----------------------'I l----._..._------ ___-„______________________________________ ------------------------------ _____ `E _____'________--___________________________ k _____________________________________---- _______-.___._ . ------------------------------------------------------------ I hereby cerfify that I red is applicafion and that the.work will be done in accordance with San Joaquin County ordinances, ./ a s, s an re ations of the Joa urn Local Health I3ts rrct. (Signed ---- -- ------------ = (Own E / -------- bnfracfor] BY=------- -------------•------------- era Trtle (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse de). I FOR DEPARTMENT USE ONLY �I t 3----- + n DATE --------- �l APPLICATION ACCEPTED-BY '- =---- ----- -------------------------------------. - ------ i REVIEWED BY - ----•DATE----�---- _ ��k' BUILDING PERMIT ISSUED9'- ------------------- ----------------------------- ------ DATE----- `--- _ E r r - - ,f, � © ,i--------------- --------------- - Alterations and/or recommend a+ 4 15 �i -�•fir -- - - ---- 1 FIN,rL INSPECTION `$Y:__= ---------�.- --.-------r �j IF � ( ; Date _: ------�------- --------------------'- ------ � F � d6n6- A AA JOAQUIN LOCAL HEALTH DISTRICT 130rSyUf Ahm ericen S r f rq:q Wef} p {?eer# `'-- 132 Sycamore Street 814 North "C" Street Stockton, Cal'fo Lodi, C'! %�alifornianteca, California Tracy, California E5-9-2M : Revised 1-57 F.P,CO. _/�I`'-� /c�?�IIF��(1