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FOR OFFICE USE . _ . ,__ _ . - ��.a APPLICATION F NITATION PERMIT Permit No. .. ---- -- -- --- . ----------- (Campl a in Duplicate] D Issued to `- ------ This Permit Ex ire ear Fr Date Issue ----- --- _ _ _ T . - . : Application is hereby made to the San Joaquin Local Heal' District for a permit to construct and install the work herein estri e . This application is made in compliance with County Ordina e No. 549. ��`� I z f_--i � - P ----------RP---�--- . c ------------- Owner s Name .----- hone. JOB ADDRESS AND LOCATIONtp . � � . y _._ r _. : ..�c ------ .�,6s�..-------��=��-�- � - Address-----•-----------• - �. •------ - Phone----------------------------------- for's =--------•--••---------------• - Motel ❑ Other ❑ Contractor s Name.....__Q- i % Trailer,Court ❑ partmeni House. Commercial.;-❑- Installation will serve: Residence 'QDD. '----------------------------"-"- Lot size ft. Number of living units: -_�"--- Number of bedrooms - "- Number of baths -- : Private ❑ Depth to Water Table "------ Water Supply: Public system ❑ f o�unity ,stem Cl: CIV.. Adobe❑ Hardpan ❑ %FHA/VA: Yes ❑ No Loam 0 I Character of soil to a depth of 3 feet: Sand Gravel 5 ndev'C nst❑ruc olny Yes ❑ No L (i#yes, date---------------- 1 ) N N Previous Application Made: L-.•.>•rTYPETOF-INSTALLATION;AND-S'PECtFIC-A-T-10 .- 1 (No septic tank or cesspool permitted if public sew is available within feet.) � �'�_ Ma erial_..+ Ca acit � GQ ` I Septic Tank: Distance from nearest well--- ---- f�/ epth---- ------------------- P Y No. of compartments-.-._-� --�-- ---5 e--- �'� - ' I-iquid d }ante from fauna ion..-.-- " Distance to nearest lot line_-,------- �__.-. stance from,fbundat�on.".. -- Disposal Fi Id: Distance'fram nearest well._- ---- 0---- ------.Width of french-------- - --------- j � nth of Each line.. -- Number of line`--------J-- g throf`filter material..... "--8- rt__Tota4 length------------------------ "" -$ �D . Type of.fil`ter material-. �-!C _ � 1 ' f Seepage Pit: Distance-do. nearest"well-,---------- ----- !s}once from foundation....-..-..-.._..__..Distance to nearest of rna.."--._"-------• Numb r`of pitsr Lining m te_i6l:_ Size: Diameter- Depth------ ❑ Distance from nearest well.._............. istanc e from foundation_..--_----.._..-._-.Lining matperialy-_ ------'------ a Cesspool - -. ..__._Liquid,Ca otic gals. ❑ Size: Diameter.--------------------` L �a v " Distance from nearest building-_- ------------------------------- --- 1 - --------------- Privy: Distance from nearest well---------------" -----�- -----.--•--- 1 ❑ Distance_to nearest lot ine_.__. .--------: --� --------------- ' ! -----• -- ---- =---------------------------"-------•----------I---•---- Remodeling and/or repairing Jdescnbes=_._T --------------------------- --------------------- .:; --------------------------- ------------ -- ----------- k _..-- _.._. 1 ...... ...................... i ---- ----------- ---------"--- ----------- ----- ------ ----------- -hcati nand that the work will be done in accordance with San Joaquin County ----------- I hereby certify that I have:prepared this app i ordinances, State laws, and rules f and regulations of the San Joaquin Local Health District. (Owner~ ( r „- r and/or an g d � ( -- - ---- - - Si ne I -- — --- - - r ' Titlel sY � (Plot plan, showing size of lot, location of system in rel ionto wells, buildings, etc., can be place on reverse side) FOR EPARTT USE ONLY ---:!7---------------t ----- ACCEPTED --- DATE----- ---� k -------------------------------------------------------- - ------- REVIEWED ----- - . DATE APPLICATION ACCEPTED BY_.._��- - -� --- �- -- , ,_ •, DATE------- :" - 1 REVIEWED BY. - F - ----------------------------- ----------------- BUILDWG PERMIT ISSUED-- _._----- �,.^ - Alterations and/or recommendations.._ _... ---- --------------------------- ---- . . .. ----------------- -- - • 1 Date-.- -- ------ - ---- --- -------- i FINAL INSPECTION B '0 - - SAN JOA UIN LOCAL 'HEALTH DISTRICT 124 sycamore Street 205 West 9th Street 1601 E.Ha=811on Ave. 300 West Oak eel Tracy,California Manteca,California Lodi,califor • Stock+an,California l •.fu's,'.'