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FOR OFFICE USE: LG _ � --------------------------------------------------------- 2\ AP ATION FOR—3AAIYATION PERMIT Permit No. 1.. �� ... - ----------------------------------- (Complete in Duplicate) , 6 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 LOCATION�p_. /C�..../�I� Q -__�o_t!_A.___.eil.._11��e_91-a-le-__Q/a.AAe Owner's Name----------, &�, /.7.e- `s------------------------------------------------ ------------------- Phone-------------- --------------_---- Address-----------^-Z.-In -------------_----Address-----------^-Z.-Inf�--------_da4e_d,d o.....--- �,r, " -•---------•---•--------------------------------------------------- Contractor's Name------- �� c?.= 1`� i�!'--------------------------------------------------------------------- ------ Phone................................... Installation will serve: Residence``�partment House E] Commercial ❑ Trailer Court E] Motel Motel ❑ Other Number of living units: __/--_ Number of bedrooms e.?_ Number of baths A_--_ Lot size _ .- �`,f "__-_________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 020021 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 1?'*'*New Construction: Yes WRONo ❑ FHA/VA: Yes R�—No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 10, Septic Tank: Distance from nearest well_-4-Q _--Distanco f3rom f yndat-ion__/®_--._____-Materi I �`'�� f�-------------- [ � No. of compartments--.4-------------------Size_�/_s:!----&Xf.dLiquid depth---_if - p y/ e i Disposal Field: Distance from nearest well_' C----_D stance from foundation../ e `e___.D�stance to nearest lo) lines ......... ®— Number of lines.-..Jr--__�___ .___.__ Length of each lineZeOf__&_ 40�Vidth of trench..,:?---_______-_________________ Type of filter material/i a�Depth of filter material--A? g � -- -------- Total length Seepage Pit: Distance to nearest well.----------------_----Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits---------------._---Lining material ___-_-------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well___-___---__•.Distance from foundation--------------------Lining material_-..-..-.__.----_--__---.---___-_._. ❑ Size: Diameter-------------------- ----- ----------Depth-------------------------------------------------._Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well--------------------_--------------_--------------Distance from nearest building.----------------------------- -.---__._. ❑ Distance to nearest lot line ------------ Remodeling and/or repairing (describe):--.--- ------sf ----------------------------------------------------- -------------•---•-----•-------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------••------•-----------•-------------------------•-•----------------------------------- ---------- � I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------------- -�f�-<---�-�- +/-F-r~- By:------------------------------------------------------------------- - - -- (Title) • - - (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc.;can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------------�------ ------------------------------------------------------------ DATE------/ --- -_A_6---------------------------- REVIEWED 6_----------------------------- REVIEWEDBY---------------------------------------------------------------------------------- -------------------------------------- DATE------------------------------------------------------•--- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE..----------------------------------------------------------- Alterationsand/or recommendations---------------------------------------- --------------------------------------------------------------------------------------------------------------------- -------------------------------------------- - --------------------------------------- ---- - ------- . . - ------------ -- : -- ....�-..� ---------- ______________________� i/U ♦ - "• �" -' —mac i„ ----------______-------------------------------------_------__------------------------_-------------_------------------------_---------------------------------------------------------------------------- FINAL INSPECTION BY:-/.I—lr 11 -------------------------- Date J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California