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11IVi�i rVK JAMIAltutu rCRm� ' --------------------------------------- (Complete in Duplicate) Date Issued. •-------"_-_-- -____---------_----- This permit Expires 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. JOB*ADDRESS AND LOCATIO1 + CC�(_,..F7. __ _�-D-D L-�---- .�.1� D F-1 s, 5 Owner's Name--------------- ; ---a-- --- • I -------�--{-- - Y------ 1 ---------- Phone... .. ---•---•--•"--------•---------•----- A-ddress---------------- - �r/ . Contractor's Name------------------ ... -- -- -------LA • Phone. - - 4 Installation will a Reside"' ❑ Ap rime Dose Commercial ❑ Trailer Court ❑ Mo Other � 1p ®vs © rl j N,IUer o I units: __�.. I�lumber of bedrooms ... Number of baths _-�.._. Lot size--... Water Supply: Public system ❑ Community system ❑ Private �, Depth to Water Table ./P_ ft. Character of"soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No [K FHA/VA: Yes ❑ No ❑ f I -- TYPE' OF INSTALLATlONi4ND-SPECtFICAT30N5: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -R f Septic Tank: Distance from nearest well.................Distance from'foundation..........-.........MaterlaL........_-..-"...____...._....._-..----"..... �. ❑�g15+W(v ;No. of comparrf eats-:`-r--------------.- Size---------------------; Liquid depth------------------------.-Capacity------------- t Disposal Field: Distance from nearest we11... 0 "".-Distance from foundation..�5----------Distance to nearest lot line_/M...... O Number of lines_._. ----- ._i ---Length of each Ione=41 '.��/"" .f.__-..._...Width of trench_.-. - --------------------- I �Cr� " y.,,, Type of,filter material"� __ � _--.Qepth of filter material..11-_--- ------.Total length____ c�_......_----------------I Seepage Pit- Distance to nearest well----------------------Distance from--foundation---------.---------.Distance to nearest lot line......-_--._.--- ! I i. ., I l g ----- --- Size: Diameter Depth j Number of its................ ._.Linin material..: "" _ Cess ool: Distance from nearest well............._--Distanc i{ P � e fromlfoundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth-'-;e----' ' * t -------Liquid Capacity- gals. Privy: w. -e from eaves __ - �� Distan Rfrom 9earest,building-- _% uildin�Pnv Distance from nearest well __ g ` '--- -=------ f '�" 7-1 ❑— _� Dlstarfce,to nearest lot Ilne------ -------------- Re odeling and/or repairi 9 -(describe)7-IS�- *' - -.� x, .,.- �f'__,.!:-'-n 'z. . --- r�'! S �Q . 4-----~�2•-M__ p "-----a•-------e ,v,- --- --------------------------------------------------------------- ___ __ _ - -- -------------- I "hereby-certify that I have prepaied,this application and that the work will be done in accordance with San Joaquin County ordinances., State lawp,_arld rules a�egutations of the SaniL`Joa-quin'Local Health District. l 9 (Signed}-- ---- -- -1 !-_ l l l -,-------------------------- � -� r ra=t ------- ----------- a11d�°r °rte» y�� - a.�� g / .a �-------(tet-- - (Tiflel .. .. wner Contractor] Y:= --•------- -V- (Plot plan, showing: size of lot,"location of system in relation to wells, buildings, etc., can be.placed ofi reverse side). y _ FOR DEPARTMENT USE ONLY. "� n APPLICATION ACCEPTED BY = - ---- - Z ' --------------------------- DATE..." REVIEWED BY----= '------ -- ----------- _-- , �y --- -------------- DATE..."=•n.-.. -- z ---- ---- ------- •......----------•-------------- DA•TE---------------------- ----------------------�--------- Alterations ------- BUILDING' PERMIT ISSUED-----------=--------s----- ----- ------------_--------------- ---------- ( Alterati n s and/or,recommendations--------------------•------- --------•-------------------••----•----•-- ------------------ -------------•------------ -y i ................................... ......... . -........__.__-.."....______"_--........___--------------------------------.---------------- _..-.-........ ............................... -------------------- ---k-"-•—-- --------------------------------------.---.------------------------------- - -------------------------- -------------------- ----------•---- I t . ,r ----------t . -------------------------•---•---------------------------------------------- ----� FINAL ` -r-731- ---------- SAN -------- Date.. /-- INSPECTION BY:.._ ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ` Stockton,California Lodi,California Manteca,California Tracy,California r' ES 4 REVISED a-S9 3H 3-'S 3'F.P.C O. "r