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FOR OFFICE USE: `-0 i - --- ----- _ " " APPLICATION FOR .S A16N PtriMlT Permit No. _.c Q ------------- --------------- (Complete in Duplicate} Date Issued --0--="/tJ-Y�� 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 wor erein desc ibed. This application is made in compliance with County-Ordinance No. 549. JOB ADDRESS AND LOCATION_. N � ----------- ----- Owner's Name-"r--- A/_`/�------ogd,ffAq �----------`----------------- -------.--- - ------------------------- Phone----------------------•------------ Address----------- ----t 10. _ -- -- '�----- -gam° Contractor's NameIll = _/� - Ph a o e__ ------ Gl ' i Installation will serve: Residence ❑ Apartment House ❑ Co mercial ❑ Trailer, Court ❑ Motel %Ut, e - c� _ ------------------------ Number of living units: _/__ Number of bed oms _..____- umber of baths ___f_rLo# size -- e Water Supply: Public system F-1communitysystem El do*Private epth to Watei Table V ft. Character of soil to a depth of 3 feet: Sand F1 Graver❑ Sandy Loam El Clay Loam ❑ Clay Adobe❑`"WHardpan ElQ Previous Application Made: (If yes date_____.___.- I No New Construction: Yes o ❑ FHA/VA: Yes El No My TYPE OF INSTALLATION AND SPECIFICATIONS: `x .4 No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: p Distance from nearest well__ "�-_Distance from,fortrndat on__.rZe_ ___. M 1al_ lT�1G�e' ---- s t 10 pR111X �� Li uid de th--- -�--- Capacity . No. of compartments_._,A------------ ---Size-?---- - ----- - --- --- q k Disposal Field: Distance from nearest well-tFO-------Distance from foundation--�f-_----.-.Distance to nearest lot line__`"'-______ Number of lines----- -- --- --- Length of each line_z/0.0_ .... "h of trench_-------....... ------------- s My. Type of filter material _: �--Depth of filter material_"__. �._ ____Total length___- ----------------- � _Distance to nearest t line--------- ------- Seepaagge it: E Distance to nearest well_Zae_______DistanCe fro fou dation___ �r Number of pits-__.7------f_'""Lining material__ __._ f Size: Diameter_ :___.__""Dept'n �"-71 Cesspool: Distance from nearest well,_______-___.__Distance from.,foundation________________-4_11ning material__."___._.____._______.__________ _.. I ____. _Li Liquid Capacity----------------------------gals. ❑ Size: Diameter---i----------- ------------ ------Depth--------------------------------- - - q, p Y t r Privy: iDistance from nearest well------------ from nearest building___._________--___________---.--------. !I l ❑ Distance to nearest lot line---------- -----s------- ------ ------- -- -'----- -------------- --------------.--------'---------------- -------------- ------------ e �� ' 9G I Remode4ing an or _repairing {describe:-.____..__ - �-----�--_---- ---------------- "c ------------------------------- "----------------- ------- ------ ------------•--------------- -.----------- -------------------------- ---------------------------------------- -------- --------that--+ ----- I hereby certify that l have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t e San Joaquin Local Health District. —10Contractors --"(signed)_ jifle) .......... .................. --- 1 (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be paced on reverse side). I FOR.DEPARTMENT USE ONLY .� !' ---------- APPLICATION ACCEPTED BY--------- 'JAL— -------------------------------------- DATE. ----�L REVIEWED BY------------------------------------------------------------------•-- ------------------------ --------- DATE------------------------------------------------------------ REVIEWED PERMIT ISSUED-- DACE t ----------------------- -- ��--------- Alterations and/or recommenc4tions: ___"------ ----� � '= ! -----------�--------- - , yf:�------t=`- `-'�-�-�----- -- -------------------- =` - .-�- -:---------T --fit- --�3-- ---•- -=--- =------ -------`-i`"_='------------- ----------- ------ --- ----- ------------------------- --- ---------------------------- -------------- ---------`` fC i ------------------ ------------------------------- -------------- -------------------- ------- ---- ----- ---------- ---------- ---------- j FINAL INSPECTION BY:------ ��` �� c '� � Date n SAN JOAQUIN LOCAL HEALTH DISTRICT I ' " 160'11 E.41aTalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California o Manteca,California Tracy,California F.P.0 O. ~ K• f