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FOROFFICE USE - ------- *a ------------------- 'PERMIT Permit IN ................a ------------ - ----------------------------- . .-. (Complete in Du lcefe) r ,> - - ------------------------------------ .-----_..... This'Permlt Expires 1 Year Frbm Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District,fo� a permit to construct and install the work herein`described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A.1 LOCATION._:_®3 r - --------- ------ -------------------------------------------- ------------ -•------ -- ----- - ----- Owner's Name- G� ""�''a"_ cs- hoe 1i_ 1 !? � r Address Q `- - -------------------------------------------- Contractor's Name 1 -------------------- ------------------ ------------------------------------ Phone- // • j-:- -- -- / � �lf. " Installation will serve: Residl!nce ❑ Apartment House `, Commercial ❑ Trailer Courtt ❑ Mofel ❑ 'Other:❑ 3 Number of living units: ��_ Number of bedrooms __tQ__ Number of baths � _ Lot size _ a:_.?�._ 8' �__._'- Water Supply: Public system Com.munit -s stem' Private Table/07----Depth to Water Table _ Character of soil to a depth' ' f 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay ❑ Acl 'be ❑ Hardpan Previous Application Made: -llf yes,date------------_--------1 No New Construction: Yes No ❑ FHA/VA: Yes.E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: = g.[No septic tank or cesspool.permitted,if public.sewer,1s.available within 200 feet.) I Septic Tank: pr istancelrom nearest wel!!s ice_-Distanc�from foundation- J-444 ______ feria l.- j_ p rt .s....� ..Dze__f%--- SXZ4i Liquid depth Capacity _Q_ S'�' No.-of com artments____ Disposal Field: Distance from nearest well - stance from foundation_19.$7__.....Distance to nearest lot line.-j D_____-- Number'of lines^____________ _ Length of each line_�3' _"`-Y 4_._.Width of trench---- ---. -� wtf Type of filter materials.-f- 4 = Depth of filter material--- Total length___�________________ Seepage Pit: Distance-,c, nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----- i.❑ Number of pits----------------------Lining material----------.-----------Size: Diameter----------------------..Depth--------------------------------- W : i Cesspool: Distance`from `nearest"-well---------------__.Distance from foundation------------------..Lining material---------------------------------- Q ❑ Size: Diameter------------------------- ---- -----Depth-------------------.--------------------------------Liquid Capacity----------------------------gals. Privy: Distance I from-nea rest well------------__-------------.--------------.-.-..-Distance from nearest building------------------------------ ❑ Distanceito nearest lot line - ----------------------------- Remodelingand or re airn escr� 1?T'. i F X17 �rs�t ---------wiTH—j-W-----------`� ,��9-1��-S-------- A - - �� Dso br-S-1.61 l....--....FG'_R----:I,-h--�_':'��-_------SAX- ---------•---------------------------------- -------------- :_ I hereby certify that I dve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws and.r:ules and r ulations of the Sa Joaquin Local Health District. [Signed) / ! - ----------------- ----------- -------------------- -- towner and/or Contractor} } ,gyp - RY: �:------ ------------V- ----------- -- -------------- �___---------------------[Title)---- ¢ ,[,. ion-(Plot plan;showing-sireraf-lot; locat 'of-system in;relation fo` IIs; buildings, etc.,-canFbe placed- r`ever'se-side).-� til . FOR DEPARTMENT-USE ONLY I is APPLICATION ACCEPTED J Y-- ....1..r`-k .O'--------------- -- DATE------ �_ =__�5----------------- --- REVIEWED BY �: ' DATE----'. _ ------------- ------------------------- �- --------=----------------------------- --------------------------- BUILDING PERMIT ISSUE D_'1M------------------------------------------------------------------- --------------------------._ DATE. ----------- ------ ----- Alterations and/or recommendations:.;_ -----------------------------------------------------------------------------•---------------------------•----------------- - ------- ------------------- O.R`rtC►_t�fs_ H...__ l_ ------�'f�_ll_E _ Fb------- a ECR �itlS� «0 RT-=---------- --------' ------ --- ----------------------------0: ------ ` --•-------:-- FINAL INSPECT) Date - '(� S = SAN JOAQUIN LOCAL HEALTH DISTRICT { 1601 E.Hoxolton Ave. 300-West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P,CO, +