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FOR OFFICE USE: % - ............................... =_ _------�y._-_.-___.-__-._.- L.-_- APPLICATION FOR- SAKIT-ATION PERMIT Permit No. ..r / ----------------------- -- - (Complete in Duplicate) JIZ 4� ff��,, /� Date Issued .__ ____.___�///_.__� _--------------------"T_�'..- V-------------- I 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. A5449. _ JOB ADDRESS AND LOCATION-=---�jC Q----- --'7 sal . ---/7t.74h7o9 'v-s------'-----......-------------------- Owner's Name------___ __ ------------------------------------ Address---------_----- _ �. � Contractor's Name--- .._ -- ..... _ t - ----- ---------------- Phone------------------------._'--------- Installation will serve: Residence Apartment House ❑ Commercial Tr er- Court ❑ Motel ❑ Other-❑ Number of living units: __ Number of bedrooms _�Z__ Number of bath's W Lot size _'k_,S-49Q____--------------------- Water Supply: Public system �mmunity system ❑ Private ❑ Depth to 'Yeller Table .iWft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date__-----___---__ ) No ❑ New Construction! Yes ❑ No4jj�--FHA/VA: Yes:❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5�,,,a71_X4,: � --- I►Septic TanktS' Distance from nearest ell_-.Q_�----Distance(from.fo S);ion__��__._-__..-. ` real__ --.-. ---. No. of compartments.- ------._____..._-Size J_.__.Liquid depth__�l[2��__ -__Capacity.t _ �iispol Fields Distance from nea st well. ------_Distance from foundation..�.S______Distance to nearest lot line................. r Number of lines-__ _-_.__.__. Length of each line_-41_x________________Width of trench.-. __ . O Type of filter materia -De th of filter material_-- _�� Total len th__-/_ r __.. eepage Pit-' Distance to nearest well -Q0---_--Distance from foundation---/_V---___:Distance to nearest lot line -_-- /� Number of its-._ -Lining material_ p .-_--_--Size: Diameter ♦,f--___Depth_ �►* � ♦ ------------ %P Cesspool: ti Distance from nearest well-----------------Distance frqotf foundation----------_.-------Lining material------------------------------------- }Le Size: Diameter-_._ .__--.-__-__ _ ❑ -----------------Depth------------------ --------- ------------------._Liquid CapacitY---------.__.•------.-r......gals. Privy: Distance from nearest eH`_ ,.__.e:__ _.__------ --- -- -.-__Distance from nearest building-------------- ._a---:. . ...--. Z ❑ Distance to nearest lot li - i --- -------- ---- = ----- Remodeling e /or repairing (describe) 9 ------------------------------ -- ------------- ----- ----------- ------------------------------_ _ __{_ -__--__-- -- ------------ -i--y•--------------------------------- -'"' - ----------------- _-- - - -- -----. ----------- ---- ---- - --------------- "' ----- T ------------- I hereby 4ertify thft I have prepared this ap�on and that the work will be done in ac rdance with San Joaquin County ordin nces, St e4aw -and rules and regulations of the an'Joa_ uin Local Health District. (Signed) I -V -----'> f n, ------- ----- - ----------- - -----Rsfr �_Contractor) �r BY:------------------- ----------------------------------------------------------------- ------ ---(Title)------ ---------- ----------- ---------. ------ (plot --(Plot Wn;sT"io�viqlsize,of lot, location of system in relation to we , buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ..__ .. �_ _____.____ DATE7 _-_F R'EfYIE�/ETJBY` ------------ - ----- -------- --------------------- - -- - -- - ------ DATE -- BUILDING PERMIT ISSUED ------- --------------- ---------------- ------- ---------- --t ------- -------- DATE -------------------- --------- Alterations and/or recommendations:----------"^1-. ..3-_.`�__ ._-U-- _._;-_-_:_•-_{_: - r+` _ � s� --------0---_:-_:�::.__ ------------------�-+v !-;-----``-- t -�, `�� `` (i { (- ('--------------'�'``4 /''' c---------- CST °�c�--- ��_�- ,;:---�� '�'� �`� ----- ------- -,� c = _ -` �^—`—_. G----- ---- --.----- -�T�—�� -- �.� <�-�-� C = - -- - /------------- FINAL -"-----FINAL INSPECTION BY:.------- ..-- - _____ Date---_--_../ _- --- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:1r.n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.