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___________ -----------_--------------------------------- - �` -\ ?`�PPUC,� �.ON FOR AT10N r MIT Permit No. . _ .?..-.•-•- . -----.------'x'--------`---- ----------------------- (Complete in Duplicate) '`•.. --------------------------------- -- --------------- --- This Permit Expires 1 Year From Date Issued Date Issued __12_.r�..___- �- Application iAereby made to fhe�San Joaquin Local Health District for a permit to construct and install t e3work h3--3n desc9Ld. This application is made in compliance with County Ordinance No. 549. �d�S JOB ADDRESS AND LO TION--- ,--_ i>✓,Eerr Owner'siNames-- ..;... / : -- - e --:_ Address.................. __�. Contractor's Name------ ,. �� 4••� ------------•--------•-•-•----•---•--•-•--- -- ---•-•---------------- ---- ------=--- =� - `�'� = • "'w --------- ..__ Phone...GR...74.--- .,..,,,Installation will sery .-Residence,EJ—Apartment House [3-Comtnercial--[] Trailer-C-ourt,E]-Motel Other N �,�et-i--� !Number of living units: _ Number of bedrooms -------- Number of baths ........ Lot}size r Water!Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ____---. ft. Chara ter of soil to a depth of! feet Sen G avec:.]Sand Loa -� Clay Loam Clay . . i ❑ ❑ � Y t: ❑ Y ❑ y ❑ Adabe� Hardpan ❑ * Previous Application Made (If yes,daie-_�--------_______ _l No ❑ New Construction. Yes ❑ No [] FHA/VA: Yes ❑ No ❑ F _ R y TYPE OF INSTALLATION ;AND SPECIFICATIONS:. (No septic Tank or cesspool permi#edIif-pub'lic sewer is available within 200 feet.) Septic T � � p • �ank� Distance from nearest iwe€I_ _6__+DistanC ,from foundation_:' _yy��,�� No, of com artments,1._____ . ._ i # . P `r�l _..Size-444 Liquid depth_.-----�--- ---------Capacity---1� ?. � Disposal Field:, 11 Distance from nearest-well_ •• Z-Y ' Distance4rom foundation...__ .._____..D€stance to nearest lot €€ne..•*- ' r �� ! s-�._ g each line Width of trench-----• i F um en of lines. ___p..................:..�-----Length of - Type of filter material - ' pantth e ffilter material____I.C __.-_-__Total length------_�, 7 a Seepage Pit:', Distance to nearest;well:--- �_-___ .__ from foundation....................Distance to nearest lot line-.-_____.....__-- -._.- � -.. ❑ Number: of pits'---^_____�-_-_---Lining material----- ----------------Size: Diameter__.--------.----_.-----Depth_-.------------------------------- ------ -----.__,-_-- " I 4 _....__. � Cesspool: Distance from nearest weli_____1---------RDistarice fr`oiri'foundation____________________Linin material----------.-___--_____...___.___.-___ � 9 ❑ Size: Diameter.-------•------_----- •- ------._.bepth _LL__ - -_-_-----_ -_Li uid Ce :esti gals. 9 &Ocity Distance from nearest well________________ : - __-_ _ _---_Distance from nearest:buildingk' ___..______-_.____.....___._. Distance to nearest lot line--------- -------------------------------- Remodelin and/or re al m describe: . i ------- �-, 0 C4%,j ---------- 11 � -----------•----------------------•---------------------------------------• %_1•±s ----------.._------------ ------------------- -----•--------------•---------------•------------=----••---------------- ------- hereby certify that I have pr`'�"ep ed}his pe pficati�and thet=the work wiH'"bedone in accordance with San.Joaquin County ordinances. StaW laws, and rules and regulations of the San Joaquin Local Health District. (Signed) l ------------- (Owner and/or Contractor) •--------- -- ----•------------- BY: •-•=f . --------------------------------(Title}--------•-----------•-------------------------------- - (Plot plan, show' size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY e APPLICATION ACCEPTED BY._____ -x-- �-= ----------��--' -----------------•---------- -- DATE_-../-------- REVIEWED BY--------------------- - ------------ t ----•-----------------•------------- - ----- DATE-- -_:----•.------••-------------••- BUILDING PERMIT ISSUED--------------•--•----------...------- -----------••---------------•-------- DA•TE------.....-------•------------------- ; ----------- -• _. --... Alterations and/or recommendstions:----------------------_ -------------------------------------- --•------------------------•-----------------.._...------------------ •- --------------•----------.------..--------------.------- ---------- -----------------------------------------•------------------------------- FINAL INSPECTION BY:..._ �" a2 Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT ; 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Weil 9th Street Stockton,California Led[,California Manteca,California Tracy,California I E9 9 REVISED Sm$9 2M 8.61 ATLAS