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FOR OFFICE USE: ¢4.sy S. /( / -------------------------- (J --------------------------------------------------------- AP h ION PERMIT Permit No. . 0 3 --- - (Complete in Duplicate) 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 Ordinances �No. 5499. JOB ADDRESS AND LOCATION_ f / Gtt_.... _/ft�ll--alb`,.f 4dt7ll_-_ .-------- Owner's Name----- .___ __Qr _,CfL __.�l�Q,?"p , ,�Z� Address --- '___-�_•L_-T�/7-------------------------------------------•- . Q/ Contractor's Name---- ,,I"/",E� ��'0"----------------- Phone_��"7CDU!�'7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2o'L1-1'/hor Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ,_----_-_-- ---:_________________ Water Supply: Public system ❑ Community system Private Depth to Water Table�Q ft. 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 New Construction: Yes RO No ❑ FHA/VA: Yes ❑ No R4/ TYPE OF INSTALLATION AND SPECIF"'TIONS: <�' • f-_ jNb septic tank or-,cesspool perTitfe4 if public sewer is available within 200 feeh)� Septic Tank: Distance from nearest wale Distance from foundation---- . ..Material-----A Cl_ :".. No. of compartments `:_ � k -.Size...... f L;quid depth ,i5 _"-----Capacity. rerw ' Dis�esi#I eek - ,t- tbirce ,frdn nearest well- _ .- -Distance from foundation..4 .__.Distance to nearest lot line..-- ;Nlwab ` $Ftfin"es------i-----------f_- Length of each line-------0.57�y_ _-..Width of trench_ �i______._.__ .. yp of ter mateha ___: a epth of filter material._ .f*---------.Total length_-___--t0AI-Ar--• _____________ q�, Seepage,Pit: Distance to nearest well_- _ ` ' ' t,\} .�_�,__Distance`'f'rom foundation___________________.Distance to nearest lot line_... ._._______ :Nurlgec 3f.pitsening material------ ---- -----------Size: Diameter ------.- ----- .Depth__ -.------. ----.-.-- ---- CwpRgl,,, Distance from nearest well _-.--_ from fourte�e#ien _----.-- ___- .Linin materi I___ .. --- -------- 9 ,� ----Liquid Cap�dity -------gals. size: C i�rneter _::-- Privy: Distance from nearest we :____ ,._QiSf3t1 m nearest buildrh .- g ❑ l _ Distance to nearest lot line�_J� ________ _____...� _4 __ �\_L��__,___._ _, ___ _ , IRV Remodeling and/or re airing descrils� / ___ ..� / ,C� i7 �1 .,- ----------------------------- \`4 I hereby certifyifhat I have prepared flim-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulaflc ps of the San Joaquin Local Health District. (Signed)---------- _._tQ1'Yl Wil. -- ----/j-�. ------- • (Owner and/or Contractor) By:-------------------- - - ----------- --4 -•-- ------(Title)------- - -- - •--------- ----- ------ lat - (Plot plan, showing size of lot, location of system in relc Q wells,_buildings, etc., can be place on reverse side). FOR DEPAI TMENTXSE OI�ILY� APPLICATION ACCEPTED BY ._ __ � .-_-___ DATE_ ------- REVIEWED BY--------------------------------------------- -------------- ----- ---- --- -- - - -17"t------------------------------------------- DATE- ------ ----_------------.... BUILDING PERMIT ISSUED------------------------------------------------ --------- ------------- DATE------------------------------- - . ------------------------ ---------- Alterations and/or recommendations:._� acrd ' -...Q _ L�a--------------------- .-. _ ----------- ---- -- ------ - --------�----------------------------•---------------- ----------------------------------------------- --------- - ---- -- --- � L ---- - j / -¢ / = -j ----------- --------------------------- -------------------•-------•----------------------------------••------------ ----------•---------------------------------------------------------------------• --•-------- FINAL INSPECTION BY:----- - --- Date.....�- -/7- ------ ---- 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 F,P.CC.