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FOk OFFICE USE: <br /> AI <br /> --------------------------------- l, PERMIT PermtN . ..4 <br /> ------------------ APPLICATION FOR iZ3. <br /> ------------------------------ 3 <br /> -------------------------------------- ..owlCornple rplleate) Date Issued ... <br /> This-Permit Expire's I Year From Date Issued <br /> -------------- -------- 5isiorict for a permit to construct and install the work herein described. <br /> T}iApplication is hereby made +a the San Joaquin Local Health I -HRO> <br /> VN " ILPT <br /> is application is made in compliance with County Ordinance No. 549. <br /> At <br /> 0 ).�W;;;!t---------YV...O.E-----7---------- <br /> I, ­-,Uts ADDRESS AND LOCATIO . <br /> I��'T­rl--------L---------- <br /> Phone------------------------------------ <br /> Owner's Name-------------- -------RQ!5-1EN--DA1=-F-------------------------------- <br /> ­M�.................. <br /> .................-------- <br /> ------------ <br /> Address..............P,0,........3.X-----­------------------- <br /> ............................. <br /> 0 W14.E.-K..�---------------------------- ---- ----------- ------------ <br /> Contractor's Name................. ­ -1 . 1. 1 <br /> ------------------------------------- F: "' *4 <br /> Trailer Court fE] motel 01 Other <br /> Apartment House Gornmercial [I I - 4 <br /> Installation will serve: Residence VW- - - <br /> ❑ <br /> ............. <br /> Number of living units: --- Number of bedrooms 2-'Number of baths Lot size .... lea. <br /> 0 -�w ito,4rt ii.# <br /> t 0 Private'�ltp'l Water T ft.Water Supply: Public system ❑ Community sy7m I riva, C3 <br /> Sandy Loam Loam [3 Clay [3 Adobe[] Her pan <br /> Sand 0?'Gravel C3 50 <br /> Character of soil to a depth of.3 feet: Ef N a C:] <br /> 0 - , , N Yes WI ❑ FHA/VA: Yes, <br /> Made:...0fyes,d ate ---------------) No New <br /> Con <br /> Previous Appi�icltion <br /> INSTALLATION,.AND SP CATIONS:, <br /> tCIFI <br /> --TYPEt. ANDY I ble within 2001,feet.) <br /> (No septic tank or cesspool permitted if public sewer is avai a <br /> I ............. <br /> ....DistanAe from founclatjon....10--------Matprial <br /> Septic Xnk: Distance frim nearest well--- Capacity... ...... <br /> No. of compartments------ ----Sizeq depth <br /> .........Distance to nearest lot line.­4� <br /> Disposal Field: Distance from nearest weli..-5-0------Distance.from foundatioi ii <br /> E---?F <br /> g ' of each line------- reach___:-._ <br /> ----- ----*.............. <br /> Width of trench-------- - <br /> Nda' umber of lines:----- --------------Len th E i�- 4 1 <br /> 4 jf filter material---J- -------------Total length......A-381!-V------------6-Q---. <br /> Type of filter material:....-42 L5.__Depth p f h"o <br /> all- <br /> -it-well----------------------Distance from foundation------------------..Distance to nearest lot line-__...___... <br /> Seepage Pit: Distance to neare Ir-14 -----------­-----------Dh­-------------------------- <br /> ElNumber of pits---------------*--Lining mateha ------- ------------Size: Diameter ept <br /> Distance from nearest we . - <br /> - -Distanc-e from foundation— ----------------Lining material------------------------------------- <br /> Cesspo6l:-� .1' Depth-------------------•-- - --------------------------Liquid Capacity----------------------......g <br /> Size: Diameter-------------------------------- <br /> ,.tell-------- --------- Iding-- -----••-- <br /> ❑ <br /> Distance from nearest�w ------ ------------------------------------ <br /> 0 Distance to nearest lot line-------------•--------------------------------------------------------- -------------------------------- <br /> mlao A43 so V - I ---••-------- <br /> Remodeling <br /> ....................... <br /> Remodeling and/of repairing (describe):-------------------------------------------------- 't ----•-----------------•--•---••-•--------- <br /> , W <br /> i ---- <br /> ll� ------- -............ n ±-- ---------------- <br /> ------------------------------ ---- ----------------------------------------------------­---------------- -----­-------------- ......... --4 44 - , W#4 1 ------------ <br /> .. .... -------- - -------------------- -------I...... <br /> ­---------------------------------------------------- •----••-•-•----...----•----•-----••-- <br /> ----------------I------------------- -----•• <br /> ..... ---- ----------- .-, ----------11 <br /> .�-6 ---------------- x -------------------------------------------------------------------------------------------------------------- ----- <br /> ------------------------------------------------------- <br /> I hereby certify that I have prepared this application and-­--------------- -----i------- that the work will be done in accordance with San Joaquin County <br /> ordinances, State I 7s, and rules and regulations of the tan Joaquin Local Health District. <br /> igned)------------!bk--f7 owner and/or Contractor) <br /> -- -- ------------------ --- --------------------------------------------------------------- <br /> ------------ -------------- <br /> ----­------------------- -—----------------------- <br /> 'By:.................. ..................................-----------­-------------------------........... <br /> (Plot plan, showing sjjb 64 lot, location of system in relation to wells,.buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- --------------------------------------------------------------------- DATE.. . .7-4 m---------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------- <br /> -­­1PV E-- <br /> BUILDING PERMIT ISSUED------ ----------------------------------- ----------- - ----- <br /> Alterationsand-/;r' Nk----------------- --=..... ------------------­- <br /> ...............---...•--••------•----•---................... <br /> ................... ------ <br /> -----F <br /> V..;�kk.....................------------------------ <br /> --------------------- <br /> -------------­--------------------------------------------­---­---------------------------------------------------------- <br /> .. ... . . ......... .. --- -- ---- -- ------------------------------- --------------------------------------------------------------%------------------------------- <br /> t2Date_. --------------- --- ----------------------------- <br /> ------------------------ ---------- ------- - <br /> .:*:::--. .:*.'t----- ----- - ----------- -- ---- ---- - ----- ---------------- <br /> ..... ............... -------- <br /> Ael <br /> ---------- ----------- - --- ----------------------------- <br /> FINAL INSPECT - - - ----- - - ----- ------------ -- -- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h..Stf*et <br /> Lodi,California Manteca,California TraCYr California <br /> Stockton,California <br /> rS 9 REVISED B-59 2M 5-61 ATLAS <br />