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I-UKUI-FIC.t Ubt: _...__.. ............_..__. -- ------------ - - - - - AeWLICATION FOR FANITATION PEK dT Permit No. --- ------ - ---- ------------ -- ---------- (Complete-in Duplicate) qq _...___........._. This Permit Expires 1 Year From Date Issued Date Issued \.l.-_.. a C� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein"descrbed. This application is made in complian a with County Ordinance No. 5499..x/ JOB ADDRESS AND�LO,CATIO .CaP.._._.L-REWAR C".._.._/...a:F �J'---/. __SD__-.--_. �RoP' Owner's Name..............t_EDD,-5.......�1.VE_S---. C4_VCa Phone i Address------------------- �6-q - l.....FR.EYV 1RT......R.I? -- - qTHri01� ......`. �` --------- '- - Contractor's Name-- N�r..................- --a - -- ...................... -- - -I.------ -- --- - ............ - . ---- -.... Phone......7 -' ------- Installation will serve: Residence ❑ Apartment House ❑// Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units:__ Number of bedrooms _6_.. Number of baths 3... Lot size_.Af R E J04 99_._., Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑,Adobe ❑ Hardpan 0 Previous Application Made: (If yes,date.. ...... I Norte J New Construction:--Yes -No ❑<' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avgiilable within 200 feet.j- - Se tic nk: Distance from nearest' twelL.... v...Distan e f o sof 'un tion:--m. ._.....Material CRETE, rllG p No. of compartments__._-_..........Size.-----.P�.�_Liquid depth_--- Capacity'...'. 5 6-6 Disposal Field: Distance from nearest well..... ...Distance from foundati .�0....._.Distance to nearest lot line_5..:.. p p of 9 r Tueboffiltermaterial-L_p. K..._Dethhofffilter�matenel.._ Z�)Y.--._.:otalhlenthnch._._....�Q�---_ ------- Type -_ YP Seepage Pit: Distance to nearest well.........m............Distance from foundation..........—_...Distance to near lot line-_-------------- . ❑ Number of pits--- ---...-..--------Lining material..... Size: Diameter.__..................Depth.------__..__...__....______. Cesspool: Distance. from nearest well ..........__.Distance from foundation_ ..Lining material_.ef--------_.._.___.._..__._ ❑ Size: Diameter. .. .............. .......---------Depth................L.... ....... -------___Liquid__Capacity._-............---------gals. Privy: _ __ _. Distance from nearest well......._.. --------------....... --......._-_.Distance from nearest building.............._...:---------__.__.:... ❑ Distance to nearest lot fi,4e _.... , Remodeling and/or repairing (describe):-___.4L2L ------FRom.....'ri91N_ ......_EXCJk. S)_S(.W.. .__ t'Acv_7___ :_ : ---------. ?8G1_T - 4b& -Yt7N.K.._ 4EFs�.-- --T} 02x -- � /A ------ .........kSMF-O-----M-HAr -,tL?r-- _......PlAiSE.D-------` o.......r - Fv�E------ i V----------- ----........I------------ ----- _ Ihereby certify that I have prepared thit-application and that the work will be done in eccdrdancel with $an Joequin.Coun+y ordinances,, State laws, and rules and regulations of the San Joaquin Local.Health District.• (Signed)--- F ^..l-!-.1...:..- - - _.- --=::.:------------ _:--.:.:-..-=(Owner end/or Contractor) By ............................................................. - .................... -----------------(Title).-----------------........ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT'USE'ONLY APPLICATION ACCEPTED-BY- '{-`�'_'R 'Q -` .:.. - ... DATE---'-_?-----2-i 7 BUILDING PERMIT ISSUED.------ -- --1. -- .... . a - DATE -�'+`-r7- ......................... ....- �- REVIEWED BY---........ .. .......� N_R r.i::..L A�R -- - - ._... - - - r � -DATE.—__z............-.........------------------------'-- Alterations and/or recommendations:_._ . - 1 ------------------.........-•--......------.... ---...---'-- -------- ------------- --......------------....--- ..---- .-.............-........ ... ......------- ---------•- ........................ ..... - -- ZR ........: ..- --"-------------------------------------------------------------------- -- FINAL INSPEC .... .. .. . ...... Dete...__....lQ_'..� '_.!G .......-- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 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 Vongoard Press