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FOR OFFICE USE: ---------------- -- ------ ------------------- ---- _-_--___-_-.--- APPLICATION Fo". NlTATION PERMIT Permit No. u hcafe /y C� ---------------------------------------- --------- (Com lPefe•in DP• I Date Issued ----- ------------Y---___t-..---._.-_. 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. ZZ v<iU - /.3 JOB ADDRESS-AND L 'E _�>.-.. lT �EAI�_ _-� OCATIO Owner's Name------�------- ----��--f-F-F--------- f__Y__'---------------- ------ ------ -------------- ----------------------- Phone-----•------------------------------ Address------------------x,11---+�./ ��_-- .__.. —Q��t��'r�. 4 --•-----•-- '' Contractor's Name------ �i/tlilll l --_----•------- --------------- --------- ------ Phone----------------------------------- - } Installation will serve: Residence Er-'-Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ O er ❑ .E Number of living:units:-.1____ Number of bedrooms 13- Numbertof baths 12 Lot size -- -490 ____.r----- -_---_.____ l (� Water Supply: Public system ❑ Community system ❑ Private.. Depth t)Water Table j5'- fLtt� © X �y� ), Character of soil to aepth of 3 feet Sand Gravel ❑ Sandy L 'am ❑ Clay Loam ❑ .Clay ❑ Adobe 5(] Hardpan ❑ Previous Applicata In Made:. (if yes,date---- I ..No l ew Constructicn: Yes �❑. FHA/VA Yes ��No ❑�..- - 4 11 + --TYPE,OF„JNSTA LATION_AND_SPECIFICATIO.NS:._:�, (No sepfic tank or cesspool permitted if public sewer is available`wifhin 200 feet..) Septic nk: Distance from nearest well.___-_-Distance from �oundatio 1----_16 16------ Mater ... Noof compartments--- .--------.--Size-- - (. _ -;! _��.Liquid depth._---- - - --Z�._.-Ca pacity__..I_2Q_ --- Disposal eld: Distance from nearest well..--_4P____Distance from foundatio __ s ��_______-_.Distance to nearest !o+ Nu Number of lines.--__---_--•�----___-_---_Length f each line._.---��---_o�-_-_.Width of trench....____,��-.�` Type of filter material___- :C _Depth of filter material__-.�_ Total length__.-_..-.� Q__-__________.- r Seepage Pit: Distance to nearest weft-.--__-.__-.-..-----Distance fromjf�.ounclation_____ __________.Distance to nearest lot line----------------- El {dumber of psis--- --------- -_Lining material-_____..-__ 1----.- Size: Qiameter Dept h--_-.______________________ Cesspool: Distance from nearest well ----------------Distance I� k 41foundai-ion Lining material__-------_------_____________________. Size: Diameter- _- --------- Depli,-------------------------------------------------Liquid Capacity.... gals. Privy: DJance from nearest well------------------------1`------ -_-_-____ _Distanpe' frorr nearest building....------.-------------------............ ❑ Distance to nearest lot lane --- -------- ---------! ---------- ----- Remodeling and/or repairing (describe :...___ . ._�` Alll _-- 'T.-- 5 r, D_--___ � __-i.�_�-_____VV1T14___- i � R -------------------------------i------I------------t�i> -il�6rp:i _�t� ?�. ---. - i ------------------------ -- ---------•----- `'�' --------------I------------------------------------------------------------------------------ -------------------------------- - -----------------------------------hereby cer+ify +hI - --------------- --------------------------- ``----•---- -- •------------------------------------------------ ------------------------------- k of I have prepared this application-;anld that the work-will be done in accordance with San Joaquin County ordinances, awsl and es,and regu Y io of rf San Joa in Local Healf}1 District. (Signed) -- . ----- ----------------- ............ - - ----- (Owner and/or Contractor) - - -.,.�..� ... - .- (Title).................... ..----- --- By: - -------------------------------- ------ -------------- — -------------------------- - (Plot plan, showing size of lot, location of system in relation a wells, buildings, etc.. can be placed on reverse side). FOR DEPA`t'tTMENT USE ONLY APPLICATION ACCEPTED BYE.-Cis ---------- ------ -------------------------- DATES ------------------ �`� REVIEWEDBY----- ------------------------------------- #----------- DATE------------------------------------------------------------- BUILDING PERMIT` ISSUED-------- -- ---------------------------------------------- ----------- DATE--------------------------- Altera+ions and/or recommendations:____-_---_- -.-.. I __-- - ------------------ _ . .---------- --------- 1---7- --------------- ----- ----- ------ - - - - - ------------------ =R: -- :�1•:� ' .ter_ __: LVt - -._. -�—�f _._ -------•--------- - -- ......... -A-- ---- . .._. _ ------------ - ------------------------ -- . I--- ----- -- . --- - - --------- ----- ------------------------------- FINAL INSPECTI 1 Date---------------3 . 1 = ------- ---- --------- - '; SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Houlton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vuripurd Press '