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FOR OFFICE USE: �/ ~ 1 /.G.r..F'_..... ��.�G .... lj. a) APPLICATION FOR = 'ATION PERMIT Permit No. ct -.. ... .. 1complafe , 't;c"el This Permi: .-zpirr, 1 "•ar,From Date Issued Date Issued Application is hereby made to the San Joaquin Lo-ai Hozl;h 04frict for a permit to construct and install the work herein described. This ep l��ica�tio'n is made in con lienee with ou y Ordinonce No. 549. JOB A�6DF2ESS� D LOCATION . ..........'....,�fO�.T.l.�......12.-.. ..... .F..�,�N...1 D. .N....l...-... rs Owner s Name...... ... .5. .L,�n�.n�r.......... � y e........... / �•'........ . ..._.................................... i Address............... ......>'v�........ .... (. L�1 .... .PC, !........� r V............. Contractor's Name............ ...�. � �.V......1/U..��/. / ... ... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo;el ❑ Other LV Number of living units: ....... Number of bedrooms........ Number of baths ...1... Lot size Wafer Supply: Public system ❑ Community system ❑ Private { Depth to Wafer Table 2Sft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay Q Adobe Hardpan❑ Previous Application Made: (If yes,date. .. ) No [K New Construction: Yes X No ❑ FHA/VA:Yes❑ Nog TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well. r��....Distance from foundation../r��......Materiel. :. ..... 1, No. of compartments...~fi.... ............Size. x.�1.)C. .... Liquid dePth.,S2.11.. ....... Capacity...�Q..Q. .... Disposal Field: Distance from nearest well /� f 2 ••._ .. 3��.....Distance from foundation.....Q ......Distance to nearest lot line...�� Number of lines.. .. .. .... Length of each line...yjr�....n........Width of trench..Z.47..' .....••.••.•..,.,c�` Type of filter materiel _. Depth of filter material.. /1....�.....Total length...?4.............................. . � Seepage Pit: Distance to nearest well.3.V........Distance from unc_aiion..¢4i•......Distance to nearest lot line... . .... , Number of pits.&-kl_a . ._Lining materiel... .3.3.�..- r �. Size: Diameter... ... . Depth..2.S`.................. . Cesspool: Distance from nearest well................Distance from foundation _............ . Lining material.............................. '.': ❑ Size: Diameter... ............... ..............Depth............... ................. ...............Liquid Capacity............................gal Privy: Distance from nearest well......-.... Distance from nearest building ❑ Distance to nearest lot li P .... .. ........................._.............................................................. Re e' g n ... . ....... d/or repairing (describe):.. .. .. .......L.G(1�.....' I1y-1=1%c-t••.... ..................:...................... ............................................. ... ........................ .................................... ............. . _................................................. ......... .........................._)V/ .. ............................ ............ .. ..�_.................----................GT/ �il�>.�................. .... ......*....... I hereby certify fh a pr red this applicatio and that the work will be'done in ccordance with San Joaquin County ordinances, State I s, and rules arL4 regulations of the San Joaquin Local Health District. (Signed)... .......... ...................... .....Q . 61,.X S. .�_ . .....mac?. .N S.._........... .. (Owner and/or Contractor)By:.... ..... .... ts-. 6 �.._. . . .......I..... .. r ................( +le)...... _............. (Plot plan, showi tze of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY \ APPLICATION ACCEPTED BY.... ... ............................................. DATE........... ... ..... < REVIEWEDBy............................ . ....... _. ..... .................................................. DATE... .....-........... ................................... BUILDING PERMIT ISSUED........ ......... ..... ....... _..........._..................................... DATE............................................................. ................................. Alterations and/or recommendations:. .. ............................................... __............ ........ ...... . .. .. .. .. .. .. _. .. . ._-. .................... ...................................................................................... ................... ..... _ . ......... . ............. ..... .. ... ..................... ......................... .... ............................ ... ... ................................. FINAL INSPECTION BY:. .. .`._ .� .: _.. Dote.... ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi Callfornla Manteco,California Tracy,California E1'.9 2M 1.6: Vanquord P-1