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zFONOFFICE USE; _. ---------------------- --------------- APPLICATION POW-MNITATION PERMIT Permit No 7 _------- ------------------------------ I (Complete in Duplicate) -------------------- ------------------- -- This Permit Expires I Year From Date Issued Date Issued _1 I 1?e-07t-03 -- - - -- ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor ---- k herein described. This application is made_'a-compliance with County Ordinance No. 549. > JOB ADDRESS AND At i Owner's Name__.---------- --- ---------------------------------------....... H�----------F.�t;�.. ........... -------------------------------------------------------------- Phone Address---- - ----- C __F ----------Z 4 f 5---------------- NONNI ------- Contractor's Name.__6-04 IV ---------- ---------------- ---------- ----------- --------------I---------------------------------- Phone Installation will serve: Residencee Apartment House E] Commercial [I Trailer Court 0 Motel 0 Other 0 Number of living units: ----I-- Number of bedrooms-3. Itumber of baths I--- Lot size ---- Wafer Supply: Public system 0 Community system E]' PriVate Depth Water Table ft. Character of soil to a depth of 3 feet: Sand a-l'"vel E] Sandy 7C Clay El Adobe[3 Hardpan i lay Loam 0 ❑ Previous Application Made: (if yes dote----------- --------) No Va""New Construction: Yes FHA/VA: Yes ❑ Nof5,,,,, TYPE OF-INSTALLATION AND SPECIFICATIONS: (N10*1 septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic affik: Distance fromh nearest well---'%&_ Distance from !fo0dation 10........Mate No. of comp a'rt'm0e%= P)_ .er -7. ------- 7-77 Size- al Capacity---ZOO Zel�! uicldep�h iq Disposal Field. Distance from ntaresf_we qistanc-e,from4,foundationt:=��/.C�� Distance=4 nnearest lot line Number of liAes- ------- ------------------------Length of each line!-----9-0��_,........Width of t' Type of filte'smaterial... Depth of filter mstejal -_ M trench-------•---------- ---------------- 4', 1 ------/ -----------Total length___________________ Seepage Pit: Distance to nearest well-_____________ Distance i --------- Li "I from foLdtion tion___________________.Distance to nearest lot line-_____...__-__--- Number of pits------- t ------- -ining material----------- Size: Diameter------ ------------Depth_-._. -------------------------- Cesspool..%j Distance from nearest well--------------_-Distance from foution. Lining material--------------- F1V 1 ------------ ---- .;I Size: Diameter-------------------------------------Depth--•----------------- ------ Privy: , - Distance from nearest Well,�n - ---------------------Liquid Capacity----------------------------gals. 4 A Mstdnc6-ftbm* s building------------------------------------------ El Distance to nearest lot line 'A I W1 Remodeling and/or repairing (describe -- -------- - ------------------------- -------------------- ----------------------------------------------------- .............. ------------------------------*------------------------i-----------------*-------------------------------------------------------------------- ----------------------------------------------- --------------- ••---"----------------------------------•--•-----------•-----••------- ------------1.----0 U__��—---------------------------------------------- - ---------------------------------------- ---- -- ---------•------=------------ Ihereby certify tha -------------------- ---------------------------------- --------------------------I--------------- ............. f I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances: State laws, and rules and regulations of the San Joaquin Local Health District. ----------------__------ -----------------------------------------------------------------(Owner and/or Contractor) c or ) BY --- _------------ ----------- --(Title) ........... 7 ------ ---------------------- ------------L--------- (PIot pla'.'!showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------------------- --------------- DATE------- - - ----REVIEWED BY -- ------ -------------------- DATE BUILDING1PERM.I-T�I-SSUF[). ----------- ----------- ----------- ....... DA-TE!!!..!!_,_n.!!!!---------- Alteraflions _n-d/_o_r � ----------- ------ :�.r----------- recommerI4 ions:_ iR A t^ #A ---------------------------------------------------------------------- --------------------------------- -------------------------------------- --------------------------------------------N-------- "__--••----••_------._._...---------•--------------------- ----------------------- --- --------- ------------------------- -------- -—--------- I ,- & . - -0 ------------------------------------------------- 14 4MW ----------------------- -------------------- - -------- ----- -- - ------?n---------------------------------------- ---------------------------------------------------*------------------------ ------------------- ---------------- ...... ------ -- ----------------- (N ------------------------------------------------------------------ ---------------- FINAL INSPECTI0 tf, --- ---- Date----- AR SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak srreet 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS