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------------------------------------------ �y ,- �wi - --- -------------- �: ° IC ATION"'' AN_ITATION PERMIT Permit No. _ �r � Com le ! p, fe:to,DGplice#e) / » `% Date Issued _ � r This Permit Ex ire"s fyYarro.m Date issued F --- Applitation is hereby-madle to the San Joaquin Local Health Disci t fCi`r s}hermit to construct and ins+all the work herein described. Thi application 's malle in complianfce with Coun�tQ'rdinance No 549.:x' zs ct f JOB ADaRESS AND 3 LOCATION'`-CJ ,I i� (j j rtr � Gem �' ------------------ d _ ______....v"� � ___ __ ., Owner's Name------------it { r �_�_•- --- - vx.Y,r""'�. .,r Q�------ �- - Q-�- t ��' _ L _ t--------------------------------------- Phone-_-•------- = Address-----•-•---- T - 1 - t ! ---------- Contractor's Name'�_ ----------- ------------------------- 1 �_._. --------------- --� ------------------._. Phone............. Installa+ion will serve: , Residence t�_ ]Apartment House ❑ Commercial ❑ Trailer Court � / # � El Motel [I Other ElNumber of living units: __{-___ Number of bedrooms -3- Number df.ba.ths.;Z__ Lot size __ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table /Oft. r r Character of soil to a depth of 3 fee}: Sand +'' } l�Gravel ❑ Sandy Loam Clay Loam ❑ Clay ] wbe} } tjrdpan_❑" Previous Application Made; If yes,pP f,. f Y ddre ---_...___......1 NoLj,--New Construction: Yes s STYPE}OFINSTALLATfON,.AND SPECIFICATIONS: _ 4 T- - .. --,-..��w.r (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest- well---�� Disfanc from foundation__/�-_--- V r _ Materraf:_ CJ -_ ®� No, of compartments--------------------------SizeXX�Liquid depth__-- ` � ) ��. --- --�Z-�:.�-- Capac;tY--•1�-------- Disposal Field: Dist mice from nearest well--57_0...Distance from foundation_;.-lf .- . --___ --Distance to nearest lot linte,_Num4r-of-lines__ _____-_ ----------------Length of each line_ �__.Width of trench.---- �� T Fe-of'filter'rriaterial____h_p_.C1� th of filter material____.__l } Yp. Total length---------------l./.C--------------- Seepage Pit: Distance to nearest well----------------------Distance from T undation-------------------.Distance to nearest lot line----- El I1 u4er of pits.-•-------------------Lining material-----/�------------ Size: Diameter- -------_I Depth------------------------r-------- � � fH.-ai 1 Cesspool: Distnce from nearest well-----------------Distancg from foundation- material___________ ____ 1 1 ---------------------- Size: Diameter.-.----------------------------------Depth/.--------- A. t1_ 1 ---------------Llquid Capacity----------------------------gals. Privy: Distance from nearest we11__._--- _._ -------------Distance from nearest building--------------------------------- ❑ '" Distance to nearest lot line---------- -------------------------_..____._ Remodeling and/or repairing (describe) ------------- ----- -- '! - ------- ---- - --------------------------------------------------- --------------------------------------------------- ---•---------- -------------`----------------- ----- j�_+a_ '"`--a r rY. t ----------- ------ ► . - r a- ------------------------------------------------------------------------ ----------------'---•-----------------------------------------`=h=='-='!----------7, •_ A T I hereby certify }lia+ I have prepared this application andR}hat the i- will be done in accordance with San Joaquin Coun+y ordinances, State laws,' and rules and regulations of the San`Joaquin Local Health Dts+ric+, (Signed)_______ ___________________ �"�..............------------- •-------- %-_--(Owner and/or Con#ractor)BY:--------------------- (Title)_ 0 `� (Plot plan, showing size of lot, location of sys}em in rela}ion +o wells, buildings, etc;, can 6e placed on reverse side). —� I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ___;_ .- ------------------ ----------- ------ DATE------ � --- �� .. REVIEWED BY ------------ ----- ---------- - DATE ___________________r____.____.____.__.__. BUILDING PERMIT ISSUED----------------------------------- -------------------------------- DATE Alterations and/or recommendations:_____________________ _ _ ------------------------ ----------- -------- ----------------------• ------------------------ =---------•- - ----------------------------------- -•--------- ------- -------------- - ---- •-------------------------- ------- ----•- FINAL INSPECTION BY:------ ---t` f r --------------------------------fir-------- D --------- J_ ,S t ' si ate --------------------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi, California " Manteca,California Tracy,California I F.P.Cq. +If