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FOR OFFICE USE: )10/ 0 SOIO �jUn`l Pei 4 . q ----- ------- --- --- ---------- ----- ----------+�. *------ ---- ----------- (Complete in Duplicate) = Date Issued _______-----_-----_----__-_-__--___-__--.-.- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. dt d )-- �<�------------------------------------------------------ Owner's Name------------------------------ , ,14G`f--•------------------•--- --------------------- -------- ---------------------------- Phone-- '� u.��3 Address.........I&W......�. L.}'�•. 5 1 �cl...........5_J_Q Contractor's Name-------•-----------------------��Nec-.-----------------------------------------....... •-----•-------••----•---------------••---•-- Phone................................... � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms ------I Number of baths __/--. Lot size -------!;F$_x___/00____ Water Supply: Public system ❑ Community system []'Private ❑ Depth to Water Table D9-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®` Hardpan ❑ ^�_ Previous Application Made: (If yes,date--_----_--_.----._) No � New Construction: Yes ❑'No ❑ FHA/VA: Yes ❑ No 2--p' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O Septic Tank: Distance from nearest well__/SAP_t_..'__Distance from foundation----/A_---------Material------CA--- ---------------------- No. of compartments---- ...... --------------Size---------9X1- __Liquid depth----* ---- Capacity8 � p 0 Disposal Field: Distance from nearest well-- Wt--._Distance from foundation.- 10.-_-_----.Distance to nearest lot ine-___5......... . Er Number of lines--_____.____3-------------------Length of each line----------- -------------Width of trench--------�_._-_---------_.-___.._.. Type of filter material__P_-_NC..-_-__Depth of filter material_____�8__-__:__._-Total length_--._-_81___:__-_-___________________- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---__.-.----__---�' ❑ Number of pits.----------------_---Lining material_----------- --------Size: Diameter-----------------------Depth---------._-__-_-----____--_ Cesspool: Distance from nearest well----------------- from foundation_-_---------------Lining material------.-.__----_--.-----.--_--_---_. ❑ Size: Diameter------------------- -----------------Depth----------------------------------------------------Liquid Capacity-_-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line -------------------------------------------------------------------------------------------------- --------------------------- Remodeling and/or repairing (describe :-------- -----------------------------------------------------------------••------------------------•--------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- ----------------- ------------- --------•--------------------------------------------------- --------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and/reulations of the San Joaquin Local Health District.(Signed) r " - (Owner and/or Contractor) By:--------------------------------I---------------------------------------------------------------------------------------------------(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 -- % --------------------------------------- DATE.--------- -- -------1°--- --------------------------------- REVIEWEDBY--------------------- -------- ------ DATE------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------- ----------------- -------------------------------------------- DATE.---- Alterations and/or recommendations:----Ibrklt----� it►_..L(S?�'' r____1__ _ _ m.1rLL 1e_z 1.-p c'+ 'f - Oil--.�OAQ—_nw�_._�ease orb � � and.�l� �� K�l�._�a.._il�-�1!w.-xgy"` ------------------------------------ ----------------------•--------- ---------------------------------------------------------------------------------------- ------------------------------- ---------- ------------------ -------------------------------- ----------------------------e---------------=- ----------------- FINAL INSPECTIONt Date----------1 c�{1� - JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.