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.FOR OFFICE USE: <br /> ----------------------- --- --- <br />---------------------------------------------------- <br /> _-- APPLICATION I .,,NITATION PERMIT Permit No. .0­4";�c=:� <br /> ------------------------ - ---------------------------- - (Complet, in dapli�-ate), Date Issued <br /> -------- This Permit Expire z��ear From Date Isstied <br /> ------------------------------- <br /> Application is hereby made to'the San Joaquin Local'Henl'h District for a-perrnifto construct and install the work herein de*ribed. <br /> This application is made in compliance with County Ordinance No. 549. -1hdAZd-e-"1 <br /> JOB ADDRESS ANQ.JOCATION ------:, ------ <br /> ----------- <br /> Owner's Name----- -IE4.4-�--------Z� -----------------------•- ----------- -------- ------------------- ----------- - Pho'ne..360�-ep.-O-Z257- <br /> A* - - I - <br /> -2: --------- --•---•-•-•--•----------------------•-------------------------------------- <br /> Address--------------- ------- ------ -------------- -------------------------- <br /> ---------------------------- ----- Phone."'/---- <br /> Contractor's Name------------------- --- ----- -- <br /> Installation will serve- Residence M--`A-partmen�House [3 Co,mmorcia.1 0 Trailer Court'o Motel [j Other E] <br /> .I`,4umI;er of living units: --/.- Number of bedrooms -y- Number of baths Lot siza,------ ----- ----------------- <br /> Water. Supply: Public system E] Community systefri E]Triva W 23" Depth to Water Table' YP ft. <br /> Chat-'actecof soil to a depth of 3 feet: Sand [] Gravel M-,Sandy Loam El Clay Loam Clay El Adobe C1 Hardpan 93/ <br /> A <br /> 'iveious AP - <br /> P plication Made: (if yes,date------------ <br /> r ---------) No El New Construction: Yes o E] FHA/VA: Yes E] No E] <br />:TYPE-OF-INSTALLATION AND SPECIFICATIONS.-t :— 7 <br /> -f'a-nk-or—c�ss—pc�o-l-p-e-ri,-ni�fe—d if public.sewer is available /9 -Z <br /> -Cao septic lable wliWsr� Y00-te-e-f.j <br /> -------Distance from foundafi ----------M ------------------------------ <br /> t8n &Vt� - <br /> Septic T fbis—ce7from-ri,b,Jw�ll',:� ------ <br /> I 1�1 <br /> No of compartments-t-l"'2---------------Size-`�--K ->eZ ----Liquid --------iCapacjfy./i-SQ5q- <br /> I - I 1 67-- <br /> Disposal eld: Distance from nearest well-,5--4......Distance from foundation-,2.0--------Distance to nearest lot ---------- <br /> 'Number of lines--- ---------- Length of each line/,6Q-------,/0Q----Width' . ' of trench ;2 ------------- <br /> Type of filter material-5'. Depth of filter mater!aI--/-,�F. ..-------Total lenclfhj.-C;�O�q---------------------------- <br /> 1. Yr 6 1 - - - I - I ; <br /> Seepag Distance to nearest well-5--------?-----Distance from foundation_-24-------Distance to nearest lot Ior <br /> line.... <br /> Number of pT�ils----- ?------------ Lining material ----- Size: Dlameter---!��...........Depth-----r2-S----------------- <br /> from nearest - <br /> Cesspool; I Distance fi arest well-----------------Distance from foundation-------------- ---- Lining material------------------------------------ <br /> El 1Size; Diameter----------------------------- -------Depth--------------------- ------------- ---------------Liquid Capacity-.-.------- ----------------gals. <br /> (Distance Distance from nearest wO------------- ---------------------------------.-Disiance from nearest building-----------------------------_.----------- <br /> ElDistance to nearest lot line------------------- ----------------------------------------------------0-------------------------------------------------------------------- <br /> ARodSg,pn /oVep6 i ring -- ------- ------------ <br /> 0hWe - ---•-•------------' <br /> ----------- <br /> - ----- ---- ----- ------- <br /> --- --------------- <br /> ---- ---- ----- -- ---------- --------- --------------------------------------- ------------------------------- <br /> I hereby certify' h t I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules cmd re lafions-cif the S Joaquin Local Health District. <br /> (Qwner and/ <br /> -- --------------- -------- --------------- ------ '9�r Contractor <br /> j <br /> --(Signed]� <br /> --Dlz;i7.......... -- ------ <br /> Z'Ttl <br /> ----------------------------- -------------(Ti e)-- <br /> By: - '- - I <br /> (Plot plan, showing size of lot, location of system in relation to �Is buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTS© BY- ------�Ie- -6------------------- DATE-----Vel --------------------------------- <br /> REVIEWED BY---------- ------ ------------ ----------------- -------------------------------------7--------------------- DATE------------------------------- <br /> ---------------------------- <br /> ------------------ <br /> BUILDINGPERMIT ISSUED--------------------- ---------------------------I-------r--------------------------------------------- DATE---------------------------------- - <br /> Alterations <br /> ATE.------------------------------------Alterations and/or recommendations:-------------- --------- -- ---- ------------------------------------------------------------------------ --------------------- <br /> -------------- ----7-------- ----- --------- <br /> ---- ------- . .... -- - ---- <br /> 4 ---------lif,�"e,�e --------------------------------------------------------------------------------------------------------- --------- <br /> -- -------- --- <br /> -----a-,�;-,-i� - ----------------- --------- <br /> ---------------x---------------------- <br /> ---------- ---------- -------------------P---------.-•-.--_----.--_-.-- --- <br /> ----- - --- - <br /> FINAL INSPECTION BY:. , ------- -- ---------------------- o --------------------------------------- <br /> L �4L IC <br /> __ 4?"l <br /> 1601 E.Hazelton Ave. 32w�.io"0.9*S-free7 t 124, Sycamore Street /P--57 205 West 9th Street <br /> Stockton,California Lodi,California Ma'riteco,California Tracy,California <br /> A%ZA- <br /> a)A4/J/Plt� 1 000--0 <br />