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FOR OFFICE USE: ..._.._:b__(_2_-__�_�._i`_.__i. _'�_.��Q__._ APPLICATION FOR-ANITATION PERMIT Permit No. k --------------------------------------------------------- (Complete-in DupDate Issued licefe) �J 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 A . LOCATION Owner's Name 4�t� � = r h... - --------------- Phone ---- --- Address-------------------------- --- - ----- Y E � -- -- -------- ----------------------------------------------------- - - --- - --------------- -- --------------- Contractor's Name---- -` C � � lP ----------------------------------------- ------------------• ------- -- ------------ Phone" -------•- ------------------ Installation will serve: Residence ® 'Apartment House ❑ Commercial ❑ Trailer Court ❑t,,Motel ❑ Other ❑ Number of living units: (_-_- Number of bedrooms __ Number of baths ____ Lot size-.__~: ____________________ Water Supply: Public system E] Community system El private th to Water Table -7 ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel E] San Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardp n ❑ Previous Application Made: {If yes,date,___---- -----------)».NoT - New,Construction: Yes ®/No E] FHA/VA':Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank orspolprmittd. f public sewer is available within 200 feet.) e mfoundation__._ C__i_' ____ _M t >f. � _ ~�_ C_Se tic akDistance eDistance f oL___ ------_-.--~. a No. of compartments_._. ► S - ----- , : +T_ - Disposa field: Distance from nearest welf_!�j.!-1_.._-Distance from fo dation____ __--.,—Distance to nearest lot I'sne_ --------- T ?_ . Number of lines-------------- � _ _ _Length of e�l�i Tfh�___�-�;.___ ~____Width of trench.�.�_.� ___ r - t Typo of filter material__.�f'lsDepth of filter material - - ._l1.,.__.Total length_._.__ __ Seepa Rit: Distance to Weare well_._. - �.-_...___DistanC om o ndation___ ____.Distance to nearest I t line__.y__1_._. f ;5 P , Number of its____5!.�___- .___..Linin materiai__V'Cc C-N-i-Size: Diameter___.., � �:- � .-.___ Cesspool: ...: - Lining material------- "------------------ �... essl: nearest.well e from foundation - -❑ ize: Diameter i.,._._..._.Depth c -._._Liquid Capacity-------------------------- gals. ' i Priv❑Y Distance from nearest well.... __._Distance from'nea_r.. Y _. : ------- --------------- Distance ------- Distance r ~ y to nearest lot line___'__._ `______________ { 1 - Remodelingand or- re ai'rin describe :__-. ,_-_-- - T��__._____- a- ------�- - - - ------------------•---------------, Y x p ` � - �`q i --__ __----- --------------------------- _____________________________________________________ I herd6y certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County a- ordinances, Stat Akjws, an :r and regulations;of the San Joaquin Local#Health District. I !' _____ _ _:__f_ _-. _____... ________________ (Signed)---------- - - - - --- ,�; ---- ------__-_-- --------(.Owner-and/or Coontractor) A / I By:._.. fir= - ------{Title]-- r .� r (Plot plan, showi g ze of lot, location of syst in relation to wells, buildings, etc., can be placed on reverseide]. I , FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED,BY. . . - - -- Cx s� ------------------------------------------ C DATE -�-�-------- BUILDING PERMIT 15SUED----------- --- ---------- -- ------- ------------------------._._ DATE------------ ----------------- -------- ------------------------------------------- -- ` � REVIEWED BY----------------- - ----------- F t ... D'ATE, --------- == Alterations and/or recommendations:______.._ ________._ ..____ - - '� ~_ ---------------{ --- --------� - –, y ^�_ 411_1_ZC--------------------------------------------- ------------------------------------------------------- -------------- --------------- ------- ------- --------- ---------------------------- ------.-------------------------- ------------------------- . ------------------------------------ --- --------- ------- ---------------------------------- -------_----------------------------- -------------------------------------- l., ----------=------------------------------ -------------------- ---------------------------------------------------------------------------------------------------------- -------------------------------- O'Z�_ ---.._ FILIAL. INSPECTION BY------------- ----- ------ Date bate.--------------- -------------------�q k t AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hpzelton Ave, O West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California w Manteca,California Tracy- California i ff � 1