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FOR OFFICE USE:;: --- --------------------------------- ------------------ --------------------------------------._..-.............. APPLICATION -FC1K"'7SA'IITATION PERMIT Permit No. (Complete-in Duplicate) .....------.------.__-_...._.._.. This Permit_EiFiresm�_War FroDate Issued .Date Issued Application is hereby made to the San Joaquin Local Health,District-forrawpermit.;to..const.ruct_and-.install the work herein described. This application is made in compliance with County Ordinance No. 549. ZM 6_44a SW 57 JOB ADDRESS AND L CATION-----_-- ��I. _ t7_�_.____ r. _ f I '':�. ---- ------ i TH.r�C� ' ----- - =----- -- - Owner's Name 1 L:LI.i J� �0. _�? -.__._. :.: '' . Phone Address-------------------------lam- Aqu�A R ----------------24A" '" ------ i. ----------- --- -- -- ❑ - - --r„j �--- -------------�.;�...-'-�--------. Phone----._..------------------•--•-----• Li : E Contractors Name_.------•--_.-�-- ��-t------- -�--�. .-}----- T el ❑ Other ❑ Installa+ion will serve: Residence Apartment House r Commercial W T•railer Court, Mot 9 - r ® Number of living units: _2_ Number of bedrooms _ Number of baths_ Lot size (. I Water Supply: Public system ®''Community system ❑ Private ❑ Depth to Wate{r-Table,/:._ _ ft LCharacter of soil to a depth of 3 fee+ SandGravel ❑ San Loam ❑ Clay Loam-❑Clay C-] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_-------------' . ) No New Construction: Yes4E?"No ❑ _FHA%VA: Yes ❑ No 2_ TYPE OF INSTALLATION AND SPECIFICATIONS: g --- No septic.tank_or cesspoolpermitted if publi.c,-s/ewer.is_availa6le-w! hin._200rfee+] Septic T k: Distance from nearest well .�r.�°�'-.Disfan e from foundation_+< ----------CMate iai ea'N�CRG77- _..-. I [ No, of compartments i ' '` p �.----�--�--.,/..Size_ ./��!0-�--�-.--.Liquid depth-..--. ,-`-._-.Capacity----��_-- Disposal Field: Distance from nearest well._ �..1f11i--Distance from foundation---/_Q-_..__._._Distance to nearest lot line---J__..----- Number of lines.-------__ hf g ' ,lf�_f ,-��<--._1Width of trench-----2 �•----- --------- Type of filter material---80__G�_Depthofflter,ma:ferial-----l- --~------.;Total lengfh-_- - -------------- . �1J .] t^s.�-ta + Seepage Pit: Distance to nearest well--.........:..........Distance from foundation__--_--_t--_- --_-.Distance to nearest lot line-_______-______.- `• ❑ Number of pits--- ---------------- Lining material------------------- Sae: Dieter---t--------...........Depth......._...---------------------- I ❑ ------ ----------------Depth--- - ;Li Liquid Capacity Cesspool: SizeaD �meternearest well ________________Distance from Lin .......iqm matperial,._.._ _ -- p g Y----------------------------gals. A i Privy: I Distancd from nearest well-------- Distance from nearest building---------._,__________-------------- :_. ❑ DistancAtto nearest lot line ....._......°..-_____._. 1 - i I f - -------------------------------- - Remodeling and/or repairing (describe)..................'.------------_ ! ' t�.__------ ---------------------------------------- Gr _..____ s _-------—e ---- --'-- ----- ----- ------------- -- ------------------------------- ----------------------------------------- e __------------- ____________________ ___________________________________________ W 1 1 I hereby c rtify that I have prepared this application and that the work will be doe in accordance with San Joaquin County ordinances, Tar aw nd rules and gula 'ons of the San Joaquin Local Hel#it District. r ( / , {Signed)----- ---------------------------------- ------ ------ --------------- -----:(Owner and/or Contractor) �13 -------- - ( -----------I - D•---- Title I - -= _ - (Piot plan,showing siz oyCo+;locatio of system vela+i n+o wells buildis,gs'etc., can a placed o�n reverse FOR DEPARTMENT USE ONLY §` .I APPLICATION ACCEPTED BY 1 .- - -----------------`- - - --- ------ DATE-------/Z _Zt74-7-=--------------- REVIEWED BY------------------------------- - I - ----------- ------ DATE----------- I -- ------------- -------- --- --------------------------------- BUILDING PERMIT ISSUED-------- --------- ----- -`--- --------- -----------------------------------------2__ DATE.------------�------'--------- Alterations and/or recommendations:------*17.6 ----------------------------------- - ------•---a----------------- --- ------- ---------------------------- ----- ----------------- --- _ _ _ --- gin.-i----- P-NL'1:1's�---- - ---�. ------------ --------- ... --- -- ------------------ 1 L =, .............................. - -- ---------- ------ ------ --- -- Date._... FINAL INSPECTI "BY,. _ CJ-__ { --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California E.H.9 2M 1.67 Vanguard Press