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FOR OFFICE USE: ,.A>pPI(CATION Or 44 fIT. TION PERMi7'_' t ---- e t No. - f� r (Complete in Duplicate) Date-Issued -------------------- --- ----------------=-- -------- rY This Permit Expires 1 Year From Date Issued Applicafion..,is hereby made to'the San Joaquin Local Heal+h District for a permit to construct and install the work herein de cribed. This application is made in compliance with County Ordinance No. 54,9. ��f 4� �. �� :".. �� JOB ADDRESS AND LOCATION___--_i'`- -:'.�_ X _ � �'4 /•T�� C'. --------------�1._ - .. r OwnersName-------------------- --, --... �_...-------------- ------.- -... ----••. � --� ----- -- -- -------- -- ---------------- Phone.-�?-��-�-----------�•-- Address----------------- - � . Contractor's Name------ Installation will serve: Residence U1,'Apartment House ❑ Commercial ❑ Trailer Court Q Motel ❑ Other ❑ Number of living units-,-:7/---=Number of bedrooms . Number of baths __ Lot size --.-- _____---------------- Water Supply: Public system ❑ Corn un'i+y system ❑ Private [3-"Depth to Water Table .!67�ft. Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam [El-"Clay ❑ Adobe ❑ H rdpan ❑ h k ' �+rw• \ iii Previous Application Made: (If yes,dat ---------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ - No ❑ TYPE;OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation---------'--`T---.Material_-....-..._.-_-_-_.._____-.--------_----__-----. ' ❑ No. of compartments-•------------------Size-------------------------------Liquid depfh--------------------------Capacity-------- r Disposal Field: Distance from nearest well_/P ....Distance from foundation.__ �_ Distance, to nearest lot linne..r .. ❑ Number of lines --_ - ��- -- _l if Width of trench----� ----------------- Leng}h of each line----- ... Type of filter material.. __ ..Depth of filter material_ Ff_Xfi_I .Totaf length------ p__`.......__.______ ---- I k Seepage Pit: Distance to nearest well-__�.__________`_-Distance fr foundation_ ._--.-__.Distance to nearest lot Iine__/Q ..._ r]s Number of pits------- -----------Lining material ._Size: Diameter-17- .--. Depth-----_'577.,�--_-.__...- Cesspool: Distance from nearest well--.--------------Distance from foundation_`ri_'_------..--..Lining material----------.--------..-------_-_----_. ❑ .4.. 3,,f5ii e: Diameter------------------------------ --:---Depth---------------------------�/----------- ----Liquid Capacity------- ----._gals. f ......, r � - t --------- Privy: Distance from nearest weft-------_____________________________...____..__.Distance from nearest building Distance td�n wrest lot line_._..//..._... • .................. r Remodelm and or repairing describe i "� --------=------ ---- -�-`S-/--�ii'�-��-------�/��------------------• i ------------------------------------- ------------------------------------------------------A� 4 --------------------------------------------------------------------- ---------•------------------------------•--------- •---------------------------------•-------- --------------- ---- I hereby certify.that 1 have prepared this applica+ion Viand'+haf the work,will be done in accordance with San Joaquin County ordinances, State ,laws, and rules and_regulafions of the San Joaquin Local Health District. Ae r --� Si ned , ' � .. r ( 9 )------ - ---- ------------- r Contractor) By:.. - ----- -----------------------------------------(Title) a �• r (Plot plan, showing size of lot,40cation of y4ern in elan n f welts, buildings, efc., can be placed on reverse side). F ,_f FOR DEPARTMENT USf ONLY Glc---'----------------------- ------------- REVIEW � APPLICATIOI*!ACCEPTED BY------- _-- _-- -- ----------------- QATE....._._-- _ . REVIEWED _BY-----/-------------------- --------------- --------------------------------- --------------------------------------- i j .�— - -----n--_-- DATE BUILDING PERMIT ISSUED------------- - ------ ------------ - ---------- DATE__- -------------os+rl_ Altera#o s recommersion �` -_.r-r __ � ---------- ------------------------- --- ---- - p -- ------� -- � � ! ` ...-=--ate-`�. ----- FINAL .INSPECTION BY:.---- 1A)-;-- ------------- -------- Date- x t SAN JOAQUI OCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. �- _