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rk,�r< vrhlLt UJt: �' ' ----------------; �;�------ _._. APPLICATION FOR ,MKITATION PERMIT Permit No. (Complete in Duplicate) --- ------ ----- ---------0--- This Permit Expires i Year From Date Issued �t Issued _� - -_� -_ 17 Application is hereby made#f 2- This 1 "2.30--3/ t pP y !)tv .the San Joaquin Local Health District for a permit to-ticonstruct and install the work herein described. This application is made in compliance withiCounty_.Ordinance No. 549. . (,[� 2 Z ,. JOB ADDRESS AND LOCATION._ _ CR. U Owner"s Name Q --------- - -------------- --------- one 5 3�5 77 -------------- Ph Address - 7�------�: pF3T!`+ T----•---MI_ _hl_T:-�C{A-----,-----•--------------- i ----------- Contractor's Name.' ' . N_ __ w.> t ' ---- ------------------------------•--- Phone_... Installation will 'serve: Residence Apartment House ❑ Commerci I ❑ Trailer Court ❑ Motel ❑ Other ❑ IM .%� �. Number of living units: __- Number of,bedrooms�� _ Number of baths .,3__._ Lot size .._140------------------ ---------------- Water Supply: Public system E] Community syste gr-"'Private ❑� Depth to Water Table'_- _ ft. Character of soil to a depth'lo f 3 feet: Sand Gravel Sand Loam Clay Loam ❑ y ❑ y ❑- Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: _ (If.yes,dote..... __. ...... New,Construction; Yes o ❑,.. FHA/VA: Yes [�No ': - 'TYPE OF INSTALLATION AND SPECIFICATIONS: ' ` r3 '.414o septic tank or cesspool permitted if public sewer is available within 200 feet.) iF Septic Tan Distance from nearest well__�b.t W_Distance from foundation---J�_ COlIfC�E T-07 , , of compartments___ _ - _ Size-X/d X_,3_x-7_-Liquid depth-_ �fienal.- Capacity_.2 o4Q--_ N�; ___. lr it .... ff Disposal Field: :•Distance from nearest well C-A _._Distan e fr m Jo' ndation___/Q____.____-Distance to nearest lot tT e of fhf lines �fi rr i Number o --�._-__--------Len o c line idth of trench �L�1r N ------- Type Ater material_ 0_G _ ---Depth of filter material----._j-p--- ---Total length- '_-_ /S� ----- ---- -- Seepage Pit: Distance to nearest well ------------Distance from foundation-------------------.Distance to nearest lot line_____._______--__ ' ❑ NLmber 11 pits--- ---------'--___-.Lining rra'terial__________'-'----------Size: Diameter-----------------------Depth-------- --•--------- Cesspool: Distance from nearest well----------.------Distance from foundation-------------------___Lining material--..___.---.___--______.._. a ❑ Size. Diameter-------------------------------------Depth--------------- -------------------------- -----r----Liquid Capacity--------------------------- gals. Privy: Distance from nearest well______________.____________- . .r - -'•-----'-' ---.Distance from nearest building..._-------------------------------- '. . t Distance to nearest lot line__._ _____----------------_---- --_ - Remodeling and/or repairing (describe):--------_(qARf�A6}`__-.__�[3i-N-L�5l --------------------------------------------------------------------------------------------------------------------- rt --------------------------------------------- ----------------------------- --------- ------------------------ ------- - ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, and r,_ s and gulations of the San Joaquin Local Health District. - (Signed)---_----- ------ --- : _ ._ ,. _ = r------(Owner_and/or_-Contractor)— . BY ---------'��-•-------•--- --- = - (Title))------- ---------- - -- --- ------------ ----- --'-' (Plot plan, showing size of lot Illocation of system in relation to wells, buildings, etc., can be placed on reverse side). ,. FOR pFPARTME FUSE ONLY APPLICATION ACCEPTED By--------- Ft R,CI`_--. ' -----------=-------------------------------------------------- DATE------- `_ZO- ---- ------------------ REVIEWED BY------------------------ 1- - -----------' DATE BUILDING PERMIT ISSUED-----(M---------- ----------------------------------------------------------------- DATE----' -------------- Alterations and/or recommend1 tions:................__.____-..__._ ----------- -------------------------' ------------------------------------------ ----- ,. a' �2 --------------------- -- --------- ------ - --- --- --------------------- ------------------ ---------------------- ------------------------------------------I ' FINAL INSPECTI8N_41Y-, _ Date_.-. �a -------- ------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,Calit''�L yam•+ 205 West 9th Street Manteca,California Tracy, California .. F.P.CO. f