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I FOR OFFI,r-E USE: { r ------------------------------------------------ ---------------_---..---_-----_---..___-.------__- APPLICATION FOR NITATION PERMIT - Permit No. ._1_..7._ 4 [Cori)Tete,in•Duplicate),.��, --------------- , . t-0. -------------- This Permit Expires 1 Year From Date Issued SCAN tts ued Application is he'reby'a'rr ade,to the San'Joaquin Local Health District for a permit to construct and install the work herein described. This pp a lication is made in com )lance with County Ordinance No. 549. �%l1 Z -7- �M Sl DF— R�4 p JOB ADDRESS i�ND' L , CATION----- ---- ----�---- Owner's Name--4__ o_- 5 - - - f -- ---------------------------------- ---- Phone-.a�_,� __ZS ---- F Add ress---------------- =----------------- Contractors Name`e.-:f4AfV—T—C1f}--- -------- -------r---------- Install-ation will serve: Residence f partment House L] Commerc l,t0' 'Trailer Court E] Motel ❑ Other 11 i Number of living units: __1---- Number of bedrooms _ Number of baths - -._.- Lot size .,_______-_•---------__ Wafer. Supply: Public:system ElCo l unit .,sy m ❑ P rivate Depth to Water Table�-C Character of soil to a depthof 3 feet: S''6d Gra'v�ejx❑ Sandy.Loam ❑ Clay Loam lay El Adobe E] Hardpan E3Previous Application Made (If yes,date . `:----__ --_.J No New Construcfion: Yes 0- �o ❑ FHM/A: Yes ❑ No ®� TYPE OF INSTALLATION,AND SPECIFICATIONS: :.. . (No-septic...tank-or cesspool_permit4e.d tf-public sewer.<is_axailable_wttliin;200 fee#:)� �, Septic Tank: Distance from nearest well------..-- " --Distance from foundation -_!7•" Mate al -- ---- EXI�YIMC No. of compartment,-- ----------�-- Stze---------------------------------Liquid d� epth ;-� -----------Capacity---.'t , = ,�_und .- Disposal Field: Distance from: no, .arest well_. _----Distance from oat-on=. . .........Distance to nearest r— Fx1st/f4G Number of lines___.--. --------------------- -Length of each line- -`4-f�Q_-_Width of french......2 ______ �� y--- Type of filter;rriafienal____ -flGj�------Depth,of„filtermatenal- --_f_F� T -_tTotal�length----,�D,t'� }_--f•B� Seepag if: Distance to. nearest well.-.I O-..-.)_Distance from foundation-----ID......__.Distance to nearest lo. fine.,<_��1+ Number of pits - ------- _ g ` �G- �x r, X , Lining material:- �'S Size. Diameter------------moi,-----Delath-- --- ----- ----- Cesspool: Distance-from nearest well-------------- -Distance,.from,founda+.io .=_.__-_.- _- .Lining ma+sa ------------------------------ ❑ Size: Diameter Depth ------Liquid Capa d:t'fyf --- --------- Privy: - -----Privy:- Distance from nearest well---- ---------- ---------------------------------Distance from nearest buldingt----�_-_-_ ❑ Distance to near st 1,0_76line-------------- - ----- -=---- I----- 14.--- .....• -r-"`7 pr - ---------- c Remodeling and/or repairing (describe).-f7k90- -661XT►alf_---71D •_/- A�/ S p-Tj,5 _ `]—j�}N 0� lt.--•-•-------'=----------------- - - 0 -DD_r-Tt4 S1Na DRI- i_t=1 , 01 ---- s -------------'-------------------------------------------------------------------------------------------------—----------------------------------------------- ---------------------------------- e I hereby c ify that I have prepared this application and that the work will'•be;done in accordance with San Joaquin County ordinances;'Sa ;and rules an u tions of tits San Joaquin Local Health:Disfrict. (Si Heil v"� --- 9 - -----------------•-- ----- .; — ��Y�--------- -------------------------------- --------- (Owner and/or Contractor) ---------r----_ --- -- — _ (Title) ----- - - + (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). .� - FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY `®- --------------------------------------- DATE----�- REVIEWED BY------------------------------------------- ------------- ----`------------------------------------------ - -----------------------. -------------------------------- DATE--------- -------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- DATE _ ' Alterations and/or recommendations:-------------- ---------------------- ----------------------------------------- -------------------- y ----------------- ---------- --- - ---------------------------------- ------------- ------------------•------------rr1 -----------------------------------------------------------=----------- ---------------------------•__-----_--__.-.--_-•_--.-------------- ------ -----------------------_-...---'-- -------------•----------.-•----_----------.-_.-.__--•-•------_-__•---..-.-----•--------------------•----' - 4 ----- ---- -- --------"-...-- -- -'----- ' --- .---._-.---_---.._.-_-----__-----_--._-.------ -----__..---''- -- -'--------------------------------------------------- . 4 a.�ia+r .ate .-.++•+n'l►y+�,rt ... fs�r FINAL INSPECTIO -------------- ------------- a ----- ----------------- FINAL ------------ Q ' y 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 Tracyr California ES 9 REVi9EO 8.59 3M 3-'53 F.P.CR. f y