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I-OR'QFrICE USE: <br /> ------------------- ---------------------- --- <br /> -----------------------w__--.----__.__--.-.-__.--------- APPLICATION -FaIANITATION PERMIT Permit No. <br /> ------------1------------------- ---------------------- <br /> jComplete in Duplicate) <br /> --------------- --------------------­------------ This Permit Expi4s I Year From Date Issued Date Issued <br /> -W___ 7j6 <br /> 4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Application Im <br /> This application is made in compliance with County Ordinance No. 549. <br /> J-0A,,P <br /> C <br /> -- - <br /> JOB ADDRESS AND <br /> - --------- ---------------- <br /> Owner's Name- ------------------ -------------------- <br /> ------------ <br /> -------------- Phone----------------------- <br /> Address.... T- <br /> --------- --------- --- --------- ...... --------------------------------- <br /> ------------------------------------ <br /> _ <br /> 4 <br /> a' _M_ ---------------------------------------3-$4! ----A4 <br /> Contractor's --- <br /> ------------------------------- <br /> EtZ <br /> Installation will serve, Residence [] Apartrrj2nt.H6use ❑ Commercial El Trailer Court �'OKVetoe_tel <br /> EftOther ❑ <br /> Number of living ❑ <br /> units: I--- Number of bedrooms f baths Lot size --- <br /> Number-.10 <br /> Water Supply. Pub' I �1� 1k , - %f __- . <br /> It m D Private'E]uDepf to Wafer Table -1 <br /> lic system E] Commun y S a <br /> Character of soil to a depth of 3 4eef: Sand , Gravel ❑ Sandy Loam El Clay Loam E] lay,E] Adobe E] Hardpan E] <br /> Previous Application Made: (if yes,date---..'-.-. <br /> ---)-No Zj-' New Construcfign: Yes 0 E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS `' <br /> t-No-sepf ic.tank orcess p_PoI_perAfte. .3-pulalic-s4wer is available-within 200 feet.).! <br /> ' <br /> I . <br /> T <br /> Septic Tank: Distance from nearest well------ -----------Distance from foundation----------------- - <br /> S T1 44v- No. of compartments----Vf­j-----------Size--- I A4 , -��6' "f4; <br /> -------------- ---��AU jdl-7cde�, --------1-___T--------1 CapacitY-- ------ <br /> Disposal <br /> ----------------------- <br /> Disposal Field: Distance from nearest well <br /> 90 on <br /> .......f- Disfante from-_f'0un`jafi­' 'JT/0------Dist�nce to nearest lot line._`--- <br /> -P,------- e <br /> Number of line"]------I.-I I - LengfIf, of each line------ Wi6fh of fr�nch ----- <br /> AM Type of filter m'�1eriaI___'RRp0.d i ---------- <br /> p i - K--.--.--Depth of filter material ---------Total length'----------_, ------------------ <br /> Seepage Pit I- J f. I Ifoundation---------------- <br /> N%"- .0. 1 <br /> Distance.to nearest well------ -1-----------Distance from foundation-------------------Distance to-nearest lot line-------;-----------❑ A <br /> 11 Number of pifs_71__`----------- --Lining material]----------------------Size: Diameter----'- ....lbepfh---------------------- <br /> ---------- <br /> Cesspool: Distance from nearest wJ1_____1-----------Distance from foundation..-----------------.Lining material--Size: Diameter- _.7.-------------------- <br /> El il--------N-1_4 k. <br /> �j Depth'------------------------ --=-----_-- ----------------Liquid Capacity_--------------------------gals. <br /> Privy: Distance from nearest well ----I-----------------------------------------".Distance-f rom,nearest.building,---------------------------------- <br /> 0 <br /> ❑ Distance to nearest ]of I ine'.....I <br /> ---------------------------- ------------------------------------I-------- ------------------------------------------------ -------- <br /> Rem6deling and/or repairing (describe):----- ---- -- ------------------- ------------ <br /> -------------------- ------------------ <br /> - ---------- <br /> ----------------------------------------------------- --------I----------- -------------------- ------------------------- ------------------------------------------------.......... <br /> ---------------------------------------------------------------------------- J I -------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------:---------- <br /> -------------------------------- ----------------------m---------------- ----------------------------------------------------- <br /> ----------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared 641jap licafion and that the work will be done in accordance with S`aA Joaquin County <br /> ordinances, State laws, and rules and regu ions i if the San Joaquin Local Health District. <br /> r <br /> (Signed)__,A!�--- Contractor] <br /> ------------------------------------------------------------- or C <br /> . 41 4401ner <br /> By:------------------ IE <br /> ---------------- -- ------------77� — --------------(T;fle)-- <br /> ------------- <br /> IP - _.";F . <br /> iolot_pan"showing lie of oc I system in­refition-f�-welli;- ildiff s c <br /> Vu <br /> k <br /> -61F ENT USE ONLY <br /> KWDEPARTM <br /> APPLICATION ACCEPTED BY-__7_T!,i*R1•_0_, DATE <br /> REVIEWED BY ----------- -------------- ---------------------------------------- -------- --------- <br /> ----------- <br /> -- ----------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT-�ISSUED-zy:-,"--!--:-f--• •^" " - - _!"�"DATE-------------I <br /> -- ------------------------ <br /> Alferafijn--s and/or—recom—mend.;t-i6ris.'t-7��'7------------------------------------- <br /> ------------------------------------------------------- ---------------------------------------17--------t?n----------W_ ------------------------------------------------------- ------------- ------ <br /> ------------------------------------------------------------------------------ ----------------- I------------------------ ------------------------------------------------------------ K <br /> ----------------------------------- ---- -------- - --- ---------- ------------------------------------------- <br /> 7 - . --- ------------------------------------------------------------------------- -------------------- ------------------ <br /> ------------------- -------------- --- ------------------------- ----- ------- --- ---------- <br /> ----- ---------- --- - -- --- ----- --- - --------------------- ---------------------------- ------------- ---------------------- <br /> ---- --------------- ------ <br /> FINAL INSP <br /> ---- --- Date---------.----t ---------------7------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxeltan Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California TracYr California <br /> ES 9 REVISED B.59 3K 3`63 F.F.cm <br />