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FOR GFFICE USE: , -------------- ---- --- --- -------------------------- -------------------------------------------------- Com fete ihANIT,ATION PERMIT Permit No. l a. APPLICATION FOR S= Y t ------------------------------------ --- -------- --- -- Dupli&5fe) /Q .- - Date Issued ____-�,i-45— _________ ___---_____________________________ This Permit Expires ] Year From Date Issued + Application is hereby made to the San Joaquin Local Health District fora_ permit to'construct'end install the work herein desncribed. e This application is made in compliance with County Ordinance No. 549. MTC6 JAJ ,JOB ADDRESS AND LOCATION-- ---- /.:I� =-- ------- -/.-------�7Z_L�-'-- I�( --- ----f-_ I J �- Phone-------------------:-------------- Owner's Name--------- -----��-E()F-�-�-----------•--��?�_�i_!'__�.�- =----------------------------------------- Address--------------------------------------- E,9_5 - --=--444AATe�!%--------•------------------------------------.--- Contractor's Name... i- ----•------- ' ----------------------------------------------------------------------------- Phone-----•-•--------------•------------ Installation will serve: Residence ©}+Apartment`House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of--bedrooms Number of baths J__ Lot size �_?__._.f1 L ----------------------.- Water Supply: Public system ❑ Communysystem El Private �epth to Water Table -_e- ft. Character of soil'-to a depth of 3;feet: Sand ©!Gravel E]--Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: '(If yes,date------- _..,---------I No New Construction: Yes Er'—No ❑ FHA/VA: Yes Q No ❑ f i + INSTALLATION AND;SPECIFICATIONS: [No septic..fank or.cesspool permitted if public Sewer is available within 240 feet.) . Septic Tank: Distance from nearest well___,5 Distance from fou dation____�Q_____._.Material__- © �C -___---.. No. of comprtments_.__._� -----------Size__l/x) X -_Liquid depth____.?_____..Capacify_J?_q----__- Disposal Field: Distance from nearest well____�.Q._Distance from foundation____/0__.,____.Distance to nearest lot line--- ❑� Number of lines------- ____- _ _.-I___-__...__Length of each lineQ-. �"_. ..Width of -��___� Type of filter material._B_a<_K__.Depth of filter matdnal____ ____Total length__J___---------- ---------- Seepage Pit: Distance to nearest wrell________ ___________Distance from foundation____________--.._._.Distance to nearest lot line----------------- ❑ Number of pits------- '----.-i-- Lining material-----------------------Size:•Diameter.,-----'--------i-- -._.Depth --------------- f _.. Cesspool; Distance from nearest well______________Distance fr_om.,foundation-_.-- �,__ _..Linin material - ❑ Size: Diameter r-------�`=------------ ----------=Depth-----------' Liquid Capacity- = gals. _ _ v Privy: Distance from nearest well-----I-------------------___---------------------Distance from nearest building___.-._______-_____________-__-__..__..._. ❑ Dis#arice to nearest lot line.--'--...--------------- --------- --------------------------------- ------------------- ------------------------------------------------ Remodeling and/or repairing (describe}: ------- ------------` "---=----------- -- ----------- ------------------------------------------------------------------------------------------------- ------------- -----------------_---------_----------- ____`__Y-----------------------------------.-..--_____-........-_-____-___----___.--____---__-_____-..________-__-_.-_.----_--__.__.__ I hereby certify that I have prepared this application and that the work-will be done in accordance with San Joaquin County ordinances, Stat laws, and rules a regulations of th San Joaquin Local Health District. (Signed) = = I , t ...._.(Owner and/or Contractor --- B ` =- r-`'Title k{.--------- y:._.. [ } r r 4 ' , r -t A F'-' i'\L (Plot plan, showing size of lot, location of system`' inkrelation to wells, buildings, etc can be' placea�,an reverse side). FOR,DEPARTMENT USE ONLY�-:�,) APPLICATION ACCEPTED BY-------� RJO--''--' --------------------- --- �- -------- DATE --�-_`fc� -------------- REVIEWED BY ---------------------i- ------ ------------'--- ;- v----. DATE------- - r BUILDING PERMIT ISSUED - : ---- :7 ------.=".= DATE---- -- - Alterations and/or recommendations:-_-- r -- --- ------ --- .`- -------10-'2--`��,.�__--------AfdrV- SHAW 1"-n .L , Q�17-------C�. nt _s ? .: s t i W�! %I s' 4J„? t ------------------------------------'-'- ----- ' ---- ---- ----------------------------------- -------------------------------- ------------------------ ---------------------------------------- - --------..._.. - -- - ----------------- ---------------- ------'----------- ------ ' -------------------------------- ------------------- I f/j FINAL INSPECT Y Date.......-!(/- SAN JOAQUIN LOCAL.HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.w.cn.