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FOR OFFICE USE: 2 7-467 -------------------------------- -------- _APPLICAYTIOWFOR`%AN17ATION PERMIT Permit No. ._'__..__.__"__-.----_-• ------------------- --------------------------- 'a-`Z -IT - -.--. __ .- —(Complete in Duplicate) /;Z,- . Date Issued ---------- ------------------I--------- This Permit Eipires I 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 mad I e in compliance with e County Ordi No. 549. 'y urcl 1 5 00, JOB ADDRESS AN CATION,56.6.5.'-S - ---- ------- ------------------------- ------- ------- ------- Pko Owner's Name.- ---- - --- -------- --------------- in e4b-5 016.7-- Address------------- --------- ---------------- ------- ---- V ------------------------------------- ----------*------ ------- Contractor's Name---- ------------- • I.- --- - --------- ---------------------------------------------- Phon Installation will serve: I Residence Apartment House ❑ Commercial E] Trailer Court, E] Motel E] Other 0 Number-of living units. -1----- Number I of bedrooms -1-- Number of baths L Of size --- ----- ----- --------------------- Water Supply: Public system El Community system El Private 0 Depth to Water Tab), ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam E] Clay Loar Clay [I Adobe 0 Hardpan 0 Previous Application Made: (If yes,date - --------------i) No`X New Construction: Yes 'E_ No j FHA/VA: Yes ❑ No)p TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-fankfor'cesspool permitted if public' sewer is available 2�ith,ln !00jget.).41 I Septic Tank- Distance from nearest w6l_liiw�'�)__Distance from foundation--?e------------q vlaterial__ No. of compartments-- -.2-- --------- Li Ljid depfh__', ------Ca pacify-/_-0-0----(5 guid d Disposal Field: Distance from nearest weil._7_0 ........Distance from foundation&P.-_ -"Distance to nearest I arest lot Length of'bach 4-ine-f?_—f3.r-?3X_'Widfh of french.. _'f Number of ----------------- TyTelof filter material.-i-Z ----�Depfh of,fiffer n�aferial---/11�--------------Total length.......49.0-0-- IV VI � j -- ---------------- Seepage Pit: Distance to nearest well----------- -------bistante from fou6dation-------------1----(Distance to nearest lot line_________________ --------- NAbd7l"of pits-•--------------------Lining rnaterial------ ---- Size: Diameter---t_.....--- ------- Depth--------------------------•------ J )�r I Cesspool: Di Lance Distance rom f e from nearest well----------------Di nce f otinclafion-------------- I'Lining material__.____.- ---------------- I j I ---------- El Size: Diameter---------------------------- ----------Depth-'-------- -ILiqu;d Capacity--------.-------------------gals. Privy: stance Di frorA.nearesf well------------------------- X_'__ _ _._,._Disfance from nearest building.__.________________" -------------------- ❑ ; Distance uiiding-------------- -------------------------- F1Distance to nearest lot lt)e._.__ ------------------P----------- --------------------------- --------i----------------- - --------------------------------------------------- --- Remodeling and/ I . A . I ---i- -1 pr repairing (desc l3e)- - - ----- ------- ----------- ----- I----- --- ---------- --------- ------- ------- - - -------------------------------------------------- - --------- --- -- ----T 7----------------- - - ------------ - - ----- ----- ---- - --- - ----- ------ ----------- - - ----------- ------------ -I------------ .................5D J--------------i---- ---------------------------------------------- -------------- -----------------------------------*---------------- - --------------------------------------- I hereby certify that ve prepared this appli ion and that ihe work will 6-6-2—one tn accordance with San Joaquin County 0�i f ordinances, State laws,[ nnd ules and regulation p�of the San Joac�ujot6c�al�Health District. Cli (Signed)------------------------ ---------- - -- ------------ ------ ------- ------ --- (Owner and/or Contractor) By:--------------------- ----- - --- -- -------- --- -------Ti#le ----------------------- - ------- (Plot plan, showing size of jocafion of sysfem" in relation o wells, buildings, etc., can be plat d on reverse side). FOR PffARTMENT, YSEONLY APPLICATION ACCEPTED BY- _ �__:. 12---------------- ------f`------------------------- DATE--------- REVIEWEDBY------------------------ --------------- ------------ --------------------------------- -------4------------------------- DATE----- ---•------------ 4- ------------------------ BUILDING PERMIT ISSUED.-------------------------------------------- ---------------------------------4----------------------- DATE-------------------- Alterations and/or recommenclafions. _------------- --------4 A ---------------------- ------------------------------------------------------------------------------ ----------------------------- ---------------------------------------------------------------------- --------------- ft------ --------------------------- --------- ---------------- -------------------------------------------- --------------- ------------------------------------------------- --------Z$ ------------------------ ------------------ ------- ----- ---- ------- ----------- -------------------- -- ---------------- --------- -----ft i ----------- --- ------------------------ ...... ----------------------------------------------------------------- FINAL fNSPECTIONJ BY: Date---------- ---------- --------------- ...... -------------- --------- ----------------11 SAN JOAQUIN LOC IiTH DISTRICT 1 11 AL HEAL 1601 E.HazollonlAve. 300 West Oak Stieet �724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California P