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FOR OFFICE USE: - ---- - Permit No. _ ,l` WPL1CATlON FO{t ANITgT10N PERMIT / r --- - ---------� .� te [Complete in Duplicate i a2 A-A.�,5-- Z�---- - Date Issued -- '?---7.`_ '. This Permit Expires TYear 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. t ---------------------- JOB ADDRESS AND LOCATION_..•S~ -- _ !'.P --r_.. 1 --------- --------------- / _� �1 = ----------x- -------- Phone ...A.. - - - -- Owner's Name----- ?- "f" S.l_f1 �3 ---------------- Address_...- 5 �dfP 1�..�---- - Name--- ------•.... ....... .. G/h��----------------- --------- ------- Phone-----------�• -------------• ----- Contractor's 2 r Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number 'living units: ..'(.___! Number of bedrooms _ Number of baths ---�__ tot size ___ _ - --------- --- 45- Water Supply: Public system [R11 Community system ❑ Private ❑ Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [],,C>y ❑ Adobe 2/"Hardpan ❑ t Previous Application Made: [If yes,dote--- TYPE NoNew�Construction: Yes No E] FHA/VA: Yes E] No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolrpermitted if public sewer is available within 200 feet.) IIj i Se tic nk: DistanceIfrom!nearest welL_Am f._tDistance from l oundation--- ---- -------- Matrial-_f�'-�'��'� .---- ---- tSize"_3_'_K ��! p p No. of compartments - �de th Capacity u" Dis osal eld: Distan NumbeAof Ilnesearest well 0�----I Distance from th of eacky I ne_, n D' Distance to nearest lot __________ i p 'D a Width of trench--------------------- EY" t s Type of filter materi �/_l '� Depth°.of�fitermaterlai ',�__.fI �___-Total length___________________ Distance to nearest lot line _____ __________ Seepag it: Distance to nearest well___�lv__9�_�Disiance f �founda`tio�!.`_4_______�� r f '�r� Number of Its---------- ----- Linin mater" f� Deptn__-- 5----------------- In _ lal___h ---_.__.Size Diameter----------- - Size; Diameter_____________________ __ is}once from foundation- Cesspool: -_. _ __..__ __ Lining material____._- �.t Distance from nearest well---1 ❑ S - De�n,' h = Liquid Capacity gals. I SSP- - --------------------- -- for rom ne`earest building Privy: Distance from,:nearest well.---____-- � -. � g------------------------------------------ -------------- ---- - ------------------ -------- w� ❑ --- "'""�"'�'�' `- g `r Remodeling and/or repairing (describe):------- ----- Aj--:-------I---------------- ---------t ( I ''= --------------- ---- i 1 .-- ----`-------------------f-`--"--------------------------------I------------------- t , ------------------------- -- - ----------------------------�;---------------------- } - Ihereby certify that l have prepared +his application;and,that the ~work will be done in accordance with San Joaquin County ordinances, State laws, and rules j,and regulations of the San Joaquin LoGal'Nealth District. t � �'`` Si nedA r - '- {Owner and/or Contractor) -------.---- ---; I ar" �1'f --------------- --{Title)------- ----- - ----------------------- ............ By:- 7� ---- -- ------ ---- - [Plot plan, showing size of lot, location of system in relationjo wells buillddiings, etc can�ba placed on reverse side]. [ FOR DEPARTMENT USE-.ONLY6 APPLICATION ACCEPTED BY_.'{ r.��_.... 1. ---�- ------------- ----------------------------------- ------ DTE-- ��_- _�_ 5--- ---------------------- - ---------- REVIEWED BY------------------------------"-1-- --- ------------ ----------------- -----=------------- ------ DATE--------------------•------------------------------------- ------------ ----- ---- BUILDING PERMIT ISSUED--------= ------- ----------------------------- ---- ---- - -------------- DATE Iterations anclAor r commendations:__ ---- ------------------------------------- -------- -------------- ------ - --tea ------- ------ r -_ -- ._ !- - 4,1 FINAL INSPECTION BY:..------- --•----- -------------------- Date / .._6 T-------------------------------------------- SAN ------ -------------------------------•----SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelloo Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.Cq.