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FOR OFFICE USE. ------- ---------------------- ------------------------- i',4� _------------- -- ---------------------------------- APPLICATION FOR STRITATION PERMIT Permit No. ----------------- ---------- ----------------------------- (Complete in Duplicate) -------- ----------------------- This Permit Expires I Year From Date:lssued Date Issued Applicationis heribymade to the San Joaquin Local Health District for a permit to construct and install the work herein rein described.described.T ,sapplication is ma e in compliant p with County Ordinance No. 549. 1.cafion A4-m-7 ; �n_ - n JOB ADDRESS AND LOCA X3 TIONIUNION---------ED------------------------- -------C�aF,_L_H_o--------------------------- xj Owner's Name----------------------RA-C-140-RD ----------£---- -------- ----------- ------- Phone----- ------------------------------ Address-------------------- 6-ax...... --------MBNI_-rE��.CA__` Contractor's Name_.0_WN_F1K----------- ----------------------------------------------------------------------------------------------------------- Phone------- ---------------'----------- Installation --------------I----------- Installation will serve: Residence,Apartment House E] Commercial E] Trailer Court E] Motel L] ..Other E] Number of living units: -]----- Number of bedrooms Number of baths -3--- Lot size >< H-5—-------------------- Wafer Supply: Public system El Community system [j -Private k?"Depth to Water Table -49 ft. Character of soil fo"a7de-pth of 3 feet: Sand jT;-Gravel E] Sandy Loam F-I Clay Loani, qi�ay E] Adobe [:] Hardpan [I Previous Application iMade: (If yes,date,___'___------------ 12-""New Consfru f on: Yes Or-N, El FNA7VA: Yes o El TYPE-OF-INSTALLATION.-.1-A N PECIFICATIONS:,, _),Jf public sewer is'available within 200 feet.) " 'Wle (No septic f6ifik or peA Distance from r1pDrest we ,--------a---- anje from f M f I Septic T04 ounjafion--/d-..-- --___.Mate _,x7061CfZPF7_E_:� ------- No. of �ompartmgnls------!;WN pt 2r Si7� _L' le 2--_----Capacify-.45-D V� Li d . h-,5, Disposal field: Distance from ne&est well_-5D_E�,_sfance fr_,m`_t t ----------Distance to nearest ------ 7� Number of -------------Length of each 0...Width of french-. - ------------ ---- -------.-Total -,,Type of filter material__P?0.C)-,__,_Depth of filter material... --------Total length------------- Seepage Pit:, Distance to nearest well----_----------------Distance from founclaf ion....................Distance to nearest lot line__---.-----_----- El Number of piis..:1------------------Lining material----- -----------Size: Diameter-___----,---.-_-----_--Depth-----_.________-----------_ _ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material----------------------------- ❑ Size:.Diameter------------------------------------Depth---------------------------1------W---------'- ._Liquicir Capacity----•-----------------------gals. Privy- Distance from nearest well-------------------- ----------:--------------- -Distance from nearest building---_-------_-_______--------_----- -___- , ❑ uiAing---------------------------------- 0 Distance to nearest lot line-----------------------------i�_------------------------------------------------- Remodeling,and or repairing (describe):---------------------------------------------------------------------------------------------------------------I--------------------------------------- -------------------- - -------------------------------- ---------------------------------------------------------------------------------------------------------I--------------------------- ----------------------- -------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ------------I------I-----------------------------------•-------=--------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancis,, to laws, and eo and regulations of the San Joaquin Local Health District. a (Signed) ;-_ - - --- - ------ -------------- - Owner and/or Contractor)- By:------------------------------------------------------------------------- - ----------------------- -----------------------(Tifle---------------- - - -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPA ENT USE ONLY APPLICATION ACCEPTED BY___—T L_R:tX.'00 ---I -------------------------------------------------------- DATE-------�------ REVIEWEDBY----- ---- --- --------------------• - - ---- ------- -------------------- ---- -- ------------------------------- DATE---- --- -----:------------------------------------------- BUILDING PERMIT ISSUED_----F 11 ---------------------- ------------------------------------------------------------ DATE----- ------ Alterations and/or recommendations:-'------ ------ ------------ ------------------------------------------ ------ -------- ---------•---•-•-------:---------- -------- 1----------------------------------------------------------- ----------------- ----------------- ------ ------------------------------------ --------------------------------I------------------------------------------- --------------------------------- -------------------------F----•------------------------------------- ---------------- ------------L-------------- --- -------------------- --------------------------- ---- --- -------- ---------- - ----------------------- ------------------- - ----------------- ------------------------- ---- - --- ---- -------- --- ------- ------------------------------------------ ------- --------------------------- FINAL INSPECTIO ------- -- -- Date---------------------- --------- --------- -- --------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.L:Q.