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FOR OFFICE USE: ------------------------ -----------------'----- - APPLICATION OR ANITATION PERMIT Permit No. 1 A.Zl -------- --------- ------------------------- --------- (Complete in Duplicate) This Permit Expirez 1 Year From Date Issued 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 i'sxK de in copliance with County Ordinance No. 544. ► l9ASS l3 '�A�LOCATIONI/5/;6�,JDF----------- �E/�]-N DDIF ]`� Owner's Name------------- ��1�--�A-L---------F--1-��-L"�"� ----------------- - -------------- Phone-----------•------------------------ Address-----=-------11 ./----•--- .- EI1!I- - > TLA-------------------------------------------........--------------------......------ Contractor's Name �JUO%1 E - --•-•-------------------------••--------------------------------- ------------------------------- Phone----------------------------------- Installation:will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel E] Other El 1�D. Number of living units: _l.-._- Number of bedrooms, ___ Number of baths . _-.- Lot size X--- ------------------ _-./__-_ ___ Water Supply: Public system E] Community system ❑ Private �epth to Water Table A* ft. Character of soil to a depth of 3 feet: Sand ZKGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date---.----------------1 No ew Construction: Yes to ❑ FHA/VA: Yes ;J• No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ ~ (No"septic tank or cesspool permitted if public sewer is available within 200 feet.) M Septic T Distance from nearest well---,�O---Distance from foundation-----/ � -------Ma-�t�erial�CC/VCfCT -------- Capacity - ---- Ca acitY---lea-Q.--- No. of com artments--.-----Z�= _Size---- -3 -o,) SLi Liquid de th---.--- Disposal 'eld: Distance from nearest well-----,5...Distance from foundation---------/_.----.Distance to nearest lot line-5 of lines---------7_____----------Length of each Width of trench.___Z�4..1_I....---_c..___ Type of filter material___,R0 C/KL--Depth of filter material------ length----------------/-C----------__-- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.---.Distance to nearest lot line----------------- F-1 Number of pits----------------------Lining material---------------------.-Size: Diameter-----------------------Depth-_ .---------- -----. Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material.-.---------------------------------- . ❑ Size: Diameter--------------------------------------Depth p - Liquid CapacifiY-- ------------------------ga s. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.-..--------.-_--.-_---___._____-----. ❑ Distance to nearest lot line-------------------------------------- ------------------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe)--------- - ------------------------------------------•----•-----•------------------------------- ------------------------------------------------------- -----------------------------------------------------------------------t�> R r -------AF-__ -1&$TAOA~r1-v^i----------------------------------- -------------------------- ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereb 'fy that I have prepared this applic tion and that the work will be done in accordance with San Joaquin County ordinance , t e laws, a ru regul ions of he San Joaquin Local Health District. (Signed) a 3-------------- ---------------- ------------------------------------------- -(Owner and/or Contractor) _ _. — ------------------- ---•-- ----------------------------------------------------------------- -- A�--- Title -------------------------------- ------- --- ---- -------- (Plot plaan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--------_r.R-0...........-•-------------------------------------------------------- DATE----------.�=1-.- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE----------------------------- ------------------------------ Alterationsand/or recommendations------- -----------------------------------------------------------------------------------------------------••------ ---------•------------------------------- ------------------------- ------------------------------------------- ------------------------------------------------------ --------------- -----------------------•--•----------- ------ ----------------.-----.---------- --------------------------------------------- -----------------------------------------------------------------------•-----------------------------------------------•-------------------------------------------------------- - --------- --------- --------- -----------Lx FINAL INSPECTION BY- . . Date------------577 L 4-"--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street -Stockton,California Lodi,California Manteca,California Tracy,California i.P.CO.