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FOR OFFICEtUSEf F. APPLICATION FOR A'NITATION PERMIT Permit No. .___ _d_. 49 - Com' late en ¢ & r, ;Duplicate);' R- 3 Date Issued -.- This permit Expires 1 Year„pram Date Issued Application is hereby made to the San Joaquin Local Health Dist ri'ct`for._a'permit to construct and install the work herein described. This application is made in compliance with County Ordinance 4o JOB ADDRESS AND LOCA TION----------- Owner's Name------- - P � - r - one Address = �� '��----- ----------------------------------------------------- ----•- ... n = ) _ Contractor's Name -1']r l L ------------------- `----- '== --------------------------------------------------- ------------ Phone---rZ _ ,---- Installation will serve: Residence) �. Apartment House ❑ Commercial- El Trailer Court ❑n Motel ❑ Other E]Number of living units: ---t____ Number of bedrooms _ lumber of baths __l____ 'Lot size --. UEAGZC______________--____ Water Supply: Publie"system ❑ Community system ❑ Private Depth to Water Table __f _ ft. Character of soil to a•depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ,14 Previous Application Made: (If yes,date____________________) No ew Construction: Yes-E. No FHA/VA: Yes ❑ No�E � - _-...-TYPE OF INSTALLATION AND SPECIFICATIONS: '0" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) h Septic Tan Distance from nearest well____ ___jDistance from undation---5-___.-------Mate�aL__CDNC_R_rR- -_.-_____� o. of compartments---------_t______________Size- __X___ _ . _;_ _�_ . __Liquid depth__-,'5----- -------------Capacity_____2 Dispcsal Field: Distance from nearest well_L�_____Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of linesf---------------------------------Length of each Fine------------------------------Width of trench---------------_:------------------ i Type.of filter material__________________ Depth of filter material----------------------,Total length_______________ Qs ' Seepage Pit: Distance to nearest weil_._U_~�_--------Distance from foundation____ G_______-Distance to nearest lot line_------_________ plumber of its._ Linin material-_ jl`�'.. .__.Size: Diameter___ rn P g '� �/r/-- - Depth- - -----.4-------- ---------- 1" Cesspool: Distance from nearest well___________ ___Distance from foundation-------------------.Lining material-_-_---__________-_ ❑ Size: Diameter,-.]--------------- -------Depth -------------------------- ---------------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well-------_-----___---___.______.__.__ --_._.-___._Distance from nearest building-------------------------------------- _ ' ❑ Distance to nearest lot line----------------- - --- -------------------------------------------- Remodeling and/or repairing (describe):- p __.A13A'r�------__MA_,D�------- _ ---------- -----------gni 4y - A---N-K-------#`--- F 9G/-� �/.�c,�,D-- ---- -0 --- j - = ---------------- ----- ------------------------ ------=--------------------------------------- ---------------------- --------Tc- -------�------------------------------------------------------------ ---- - ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules-and regulations of the San Joaquin Local Health District. (Signed)---- - = � ', .(Owner and/or Contractor) By:---------------------------------------------------------------------------- ------ -------------{Title) ------- ------- --......................... ------ ...- --------- ------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- 'c ��--- ---------------------------------------------------------------- DATE ---7-7-- ---1----k�---------------- ! REVIEWEDBY-------------------------------------i;--------------------------------------- ------------- --------------------------------- DATE---- --------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations{_-_= .T,?t._ � _WEE-ISS______ ________ L��,4-!_ ._____ _ - _-------------- --------------------------- --------- ------------------ ------------- ------------------------------ ------------------------------- ---- --..-.-._.: FINAL INSPEC --------- ------ Date-------- ---------- SAN --------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I 11 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.