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FOR OFFICE USE: APPLICATION POC-- PERMIT Permit No. .d (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _' _ ItO-!TJ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. l This a. plication is made in compliancy with County Ordinance No. 549. a 'I-�;� ► t�8e3_w .4�=A_�K,2OA, IU JOB ADDRESS AND LOCATION. _____ T _RQ( _______ �_ 1e� , 4 f1 _ r Owners Name------------ �3 --=-�=•----...._.V C'-'. _Q_1 .�'OY ------------- Phone--------------------------- Address 9 -•-�- --------- Bax Q ui Contractor's Name----- E�-------------------•----------------------- ---------------- -------------------------------------------- Phone--------------------._--•-------- Installation will serve: Residence F<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J----- Number of bedrooms -Number of baths ./.___ Lot size --147_Z___.�------15- --------------= Water Supply: Publics stem Community system Private De fh to Water Table I__ ft. � Y ❑ Y Y ❑ ❑ p Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam El Clay Loam E] Clay ❑ Adobe C] Hardpan ❑,V Previous Application Made: (If yes,date____________________) No New Construction: Yes ❑ No �A/VA: Yes ❑ No 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-----------------Distance from foundation-------------------Material--------------------------.--------------------- 5 X _--__-_-..-__-___-_-5X M'T1 rJ& No. of compartments---------- - - -----------Size--------------------------------Liquid depth--------- - -------------Capacity----------------------- Disposal Field: Distance from nearest well---5. .....Distance from foundation-----EV........Distance to nearest lot line---- [� << i►�!& Number of lines----------�______________ _,��._-_____Length of each line_____. -_._.__________ Width of trench.__-_�`-- Type of filter matena__R#_C_l ------ ri _ Depth of filter mateal______ _ ____________Total length_._ _----_-----0?s------_----_-_--__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.-.-_._--_----..- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth---------------------------___--- I Cesspool: Distance from rea.rest well-----------------Distance from foundation--------------------Lining material__.-------------------------_- ❑ Size: Diameter------- ------------------ Depth--------- - ---7- ------------------ - -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------- ---------------- ----------____Distance from nearest building--------------.-__.---_---__--___.._-_.._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------•-------------------------------------- -----•---------------------------------------------=----------` -----------------------------------------------------------------------------------------r----------------------------------------------------------------------------- ----------------------------------------------- \\ ----------------•---------------•--------------------•----------------------------------------------------------------------------.....------------------------------------------------------- -----•----------- ------------------------------------------- ----------------- ----------------- ----------- --- --------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou , ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- --- ---- - ------------------------------------------ --------------------(Owner and/or Contractor) Y -- --- --------------------- (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------ ---- ------ --------------------------------------------------------- DATE- ------ - "----------- REVIEWEDBY--------------------------------------------- ---------------------------------- ------------------------------------------- DATE------------------ ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- ---------- ------- ---- Alterations and/or recommendations:---S 5�_�M______WAS_._-J�vm------FAI_L114C__.s--_®..W-W - --___CQI_l_ ___7 J, .1T .-Af- --- R.DL��__ ._�_Q�v.A,c�-..._.LF_,A9IC.)4--- 4t_/Vr_ T Imo- '--- --------------------------------------------------------- ----------------------------------------------------------- - -------- ------- --------- ----------------------- -------------- ---------------------------- -- • - •------------------------------------------ ---------- --- ---- ------ ------------------- --------- ------ ----------- ------------------------- ---------- ---•--------------------- ---- -------------- ---------------------- ...... ........ -------------- ---------- -------------------•------------------------------- --------.... ----------- --- I FINAL INSPECTI B Date------ --------- -`/�� 6,7--------- --------------------- SAN JOAQUiN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street _ 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California 'I a* Manteca,California Tracy,California F.F.CC. -