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A. FOR OFFICE USE: <br /> .....................­ ------ ------- " P <br />---------------- -....... ------------------------ - APPLICATIOWOOR IANITATIOW ERMIT Permit No. <br /> ' 4' -V I <br />..............7------------------------------------------ (Complete-in Duplicate) '- — Date Issued ----�// <br /> -- ----- ..................................... This Permit Ex fires I Year From Date Issued <br /> /7r" <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install.the work herein described. <br /> This application is made in compliance with County Ordinan-ce No. 549.~ <br /> JOB ADDRESS AND LOCATION &30/----- <br /> Owner's Name--------6--e--T------- <-- ------------------------------------------------- - ------ ----------------------------------- Phone------ ------- --------------------- <br /> Address..............1.clzo- / <br /> Contractor's Name-------- ..... ----- Phone...... ---------------------------- <br /> Installation will serve. 'Residence D---Apartment House E] ComrnercVE] T.-railer Court F] Motel ❑ Other ❑ <br /> Number of living units. mber of bedrooms�3... Number of baths--------- Lot size _2 Z - <br /> .. ----------------- ---- P <br /> Wafer Supply: Public system ��mmunify syste'm E] Private F-1 Depth to Water Table ------ - ft .. .. <br /> Character of soil to a depth of 3 feet- Sand NK"Gravel E] Sandy Loam E] Clay Loam [:] Clay-F-71 Adobe [:] Hardpan El <br /> Previous Application Made: (If yes,date_.................. ) No E] New Construction: Yes No E] FHA/VA-. Yes E] No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest weft."./CO_-Distance from foundation-. ___J-0__"__.MaferiaI <br /> No. of compartments- -------~-----------Size--------------------- - --------Liquid depth--------- ------- --- - - Capacity----------------------- <br /> p <br /> D;s I F* Id: Distance from nearest wefl...IL") . -Distance from foundation--- to nearest lot line_._- -_._.. <br /> Number of lines ------------- ........._--------Length of each line-- ------------------------_-Width of trench--------------------_-- ------ <br /> Type of filter material-------------- ----------Depth of filter material......P?-//------ <br /> Seepage Fit: Distance to nearest weft_____... _----Distance from foundation-------------------rDi s ta5c—e to nearest lot line__.___..___.___._ <br /> El Number of pits.._ -- ------- .......Lining material__-__--___ Size:f DiTmvFe—r ----- ------- ....Depth--------- --------------- ------ <br /> CesspCesspool; <br /> ool; Disfance from nearest weft _---------------Distance"from foundation----------------- --Lining'material---------- ------- ----------------- <br /> ❑ Size: Diameter- -- ----- ----- -- ----------------Depth- -------------_`-—--------_........_­.—rLig,uid Capacity----------------------=-----gals.` <br /> Privy: Disfance from nearest well____- -- ----- ------ - ----------------------Distance from :nese t bbilding- ---------------------------------- <br /> 171 Distance - ------ <br /> Distance to nearest lot line -- . i 1� <br /> ------------------------- --------------------------------------- ---------------------- ------------------- --------- <br /> Remodeling and/or repairing (describe): <br /> ----- -------------------;---------------- - -----------------------`------_=------------------------------------ ----------------- <br /> --------------------------------------------------------- ------------------------------------------------I- --------------------------- J----------I-----------------------•1-- <br /> rA' q r <br /> -------------------------------------------------------------------------------------------------------z-----------------1-1----------------------------- ---------------------------------------------------------------- <br /> ---------- -------------I-------------- --------- ----------------------------------------------------------------- -------------- /............ ------------------------------------------------------- --- <br /> I hereby certify that I have prepared this application and that the-work will'.6e-:done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and I f, f the S, <br /> -----7 <br /> ,igulat.ons o an Joaquin Local Health District. <br /> (Sie __ -.-- - - ._r--------------------L____ ...........�_il <br /> gnid)- ------- V - - - -------------------7"�--------------(Owner and/or Contractor) <br /> By:----------------------- ----------------------------------------_ .__ 1, /,--<] <br /> -----------------------=--------------- -------------(Title)------ <br /> ------------(T;fle)------ --- ------L----------------- <br /> IIS, <br /> (Plot plan, showing size of lot, location of system in relation to-we 6-uiIdihgs,:efc.. Cn'be place'd on reverse side). <br /> FOR DEPARTMENT USE 6NLY-, <br /> _&3 <br /> APPLICATION ACCEPTED 000 <br /> -------------------- -------------------- DATE--..-.. 71 <br /> --- -- --- ----------------- <br /> REVIEWED BY---- ------------- <br /> ----------------------- -------------- -------- ---------�__,DATE----- ------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- ---------------------- --j I 'DATE--------------------------- <br /> 7------------------------------- ------------------------ -------- ------------------------- <br /> Alterations and/or recommendations........ . ... <br /> ................. .... . <br /> .. ........ ..------------------------------------------------------:-------- --------------------------------------- <br /> ------------- ---------------- - I- <br /> ----------------------------------- ------------------------- --- ------------------------------ <br /> ----------------- ----------------- <br /> --------------- 74. <br /> --------- .. .....40.....A <br /> ------ --------- ------------------------------------------ <br /> --------------------- ------_--------------------------------- ------ - - - -- --------_----------------­�----------------- --------------------------------------------------------------- - -------------------------- <br /> ............ .................. ....................... ------- ------------------------ -- ---- ---------------- -------------------- ------ -------I------------ - - ------------ ----------------- <br /> FINAL INSPECTION BY:... Date------- ----------------- -----........../ <br /> ---------------------- --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California TTaCYr California <br /> E.H.9 2M 1-67 Vanguard Press <br />