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FOR OFFICE USE: <br /> ............................................ .. <br /> APPLICATION PORE"SAWrATION PERMIT Permit No. J . <br /> .--•--._. .................. --------- --- (Complete in Duplicate) <br /> ...... This.Permit Expires 1 Year From Date Issued Date IssuedA��_--&­­n <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 Ordinance No. 549. <br /> l <br /> JOB ADDRESS AND LOCATION............. "... -..._.... .--.1-�'-�2,� 11.J -----...-•----------....-------- . <br /> Owner's Name......................__,/t/1.Z!••-----/-•• l-/ 0 1. •6, ..................................... Phone rJ � y <br /> Address...................................... 4/.,--•-•------•-_,--•-•--------------------------•---•--_-- <br /> Ve-Contractor's Name. .+! . -f` -!`i'�• - .................................................... Phone- l�lo..`f .7_. <br /> - --— <br /> Installation will serve: Residence Apartment HousesCommercial ❑ Trailer Court [L�tvtotel ❑ Other <br /> fnQ 1 <br /> Number of living units: __ ... Number of bedro s .rte..._. umber of baths//Lot siz !0 <br /> / <br /> Wafter Supply: Public system ❑ Community syste rive+e,M Depth to Water Tab -4 ft. =" <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam 2--'Clay Adobe Hardpan <br /> P ❑ ❑ Y ❑ Y IY` Y ❑ ❑ ❑ <br /> Previous Application Made. (If yes,date.-------------------) No M--"New Construction: Yes M-40 ❑ FHA/VA: Yes ❑ No 3­*� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permittechif public sewer is available within 200 feet.)� <br /> Septic Tank: Distance from nearest well_. ...._...___Distance from foundation ��.i_..Material__.•_ afrr` 5�:...____.�. .` <br /> No, of compartments_-...�_................Size---L XXX.- =---Liquid depth------_`'`_.7.!P/.......Capaci f' <br /> f Distance to nearest lot L;n'e "' <br /> Disposal Meld: Distance from nearest Distance Distance from foundation- <br /> ❑/ <br /> Type or filter material, a'� ___.Do hof riper materiai___!�-��._.__...Total length...................-._`..�..; <br /> I Number of lines__..........................Length of each fine� _/�,7.__ . . -_..Width of trench.._.�_._�,�.'__. _.. <br /> Yp p if / f ,� <br /> foundation -__._.Distance to nearest lot iine__�. <br /> Seepage,Pit: Distance to nearest well,._/�._.-_._.�Distante fr�� ------- <br /> [� Number of pits...... _.._.__.___Lining materiaL_ �r!',l .Size; Diamet�r_ .�j� �DepYh�._. 5''°_.'1 ^'-.•` <br /> Cesspool: Distance from nearest well•-•______________Distance from foundation....................Lining imaterial•..1-1...._........_..._........_._ Cy <br /> Size: Diameter---------------+...................._Depth._•......._........................................Liquid Capacity.._.... gals. <br /> Privy: Distance from nearest well.... ...................................Distance from nearest building........... <br /> ❑ Distance to nearest lot Line�..'f, -•---•--........... ..........-----•....................- <br /> GJ___.._ � <br /> -•_ _____________-----------------------------------------------•------Remodeling and/or repairing (describe):__.-.-,%.../vIY.................. ---•------•-•---•--••-•-----•-....................................... <br /> .................. <br /> ................... - <br /> ' I <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws. aLnd rules and regulations of the San Joaquin Local Health District. <br /> (Signed).................. --------,G""^ (...--• •-- [Ow r and/or Contractor) <br /> By: /-,7J -r- ":--------•-•------- ------ Title ,r . � <br /> Y (Title). - ......••-......................._._. <br /> Plot len, showing s'a`e of! tion of tem in relation to wells, buildings, etc., cari be placed on reverse side). <br /> ( P . . r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ,.------ -..........................•_--- DATE--_-__-.�_1 .....1,1�� <br /> REVIEWEDBY----•--•------------------------------------------------------- ....................................................... DATE......................................-------- ......... <br /> BUILDINGPERMIT ISSUED............................................................... . ........................... DATE•-------------•--••--•------.--__-•-.------- _._.... <br /> Alterations and/or recommendations;!ti •� ........ <br /> � �. c _... <br /> •---.........?_ f_ _.._.. ....... ,................- _ ----.. --•-- <br /> ..............................._........-•-- ..........._......- %i' ...- ......_.._...... ._....f..................... ........__._._............................................ <br /> 1 . . <br /> - _. _............... .�...._ .-•-•----•--•-•-----•.,_.-..,..,-•-•-•---•-•--------••-----•-••----------------------.-,_._....._...- <br /> FINAL INSPECTION BY...-.--•-•- _.�, Date....._._ . _f..,._�.�J-`__.-.-•-•________________ <br /> ....-...fr-•--••- j I <br /> SAN OAgUIIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hardtop Me. �3000_W* bak/Street 128 Sycamore Street 205 West 9th Street <br /> Stockton,CaliforniaLLodi,California Manteca,California Tracy,California <br /> F.P.CC. <br />