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FOR OFFICE USE: - /42--01C)------- --------- - f - _-�� _.___..__.__;3, �+_.,_:_. APPLICATION, FOR ,SAN1T'AION :PERMIT Permit No. .��..!- !r�.� ..__. -------- ---------- (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta .the work he.ein described. This application is made in compliance with County Ordinance No. 549. ' _` _ 11� ,fir . JOB ADDRESS AND L CATION-_S/,e_ f �'a ------r. 1/ --/f' Y~ 1 - � � lel� ----------------- ------------------- Owner's Name Name____.. Phone---------------- __//_// Address-------- --- '� � �/!' Contractor's Name------ wlee_----------------------------------------------------------------------------------- Phone..--••-•--------•----•-----------•• rti Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 210 lotel ❑ Other ❑ Number of living units: Number of bedrooms -------- Number of baths ------- Lot size ___ --__________________________ Water Supply: Public system ❑ Community system ❑ Private [e-_iDpth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan s Previous Application Made: (If yes,date_.__.___.._.._.._) No ga"New Construction: Yes ga- No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material____...________.__..____..__________.._ ---------- No. of compartments--------------------------Size--------------------------------Liuid de th--------- --Capacity ii Disposal Field: Distance from nearest we€l-----------------Distance from foundation--------------------Distance to nearest lot line__-__-__----`..... ❑ Number of iines-----------------------------------Length of each line------------------------------Width of trench----------------------------- Type of filter material._._.-.__ f--___Depth of filter material-_____________________Total length------------------------------------------ Seepage Pit: Distance to nearest well_ -.-__Distance fro fou ation__A7__.---___ Distance to nearest lot lire___ _6_.. ¢ Number of pits___._�-----------_Lnng material--- '� - Size: � Depth-. ----- - ------- -'-- qk Cesspool: Distance from nearest well----------____---Distance from foundation--------------------Lining material-----------------------------------__. ❑ Size: Diameter-------- ------------ ----------------Depth------ ------- ---------- -------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____._._________________ Distance from nearest building__..___._________________..___.._ k Distance to nearest lot line________________________________.________ _ k t❑ /- ------- 6A_ __ »E f mom/_.z-_ B-------------------------------Y �7 Remodeling and/or repairing (describe):--------- � _� � � ----- ---------------------------------- ------------------------- --------•-----------------------------------"-------------------------------------------------------------------------------------------------------------------------- I hereby certify that 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. , `\\ F Jh t (�rnterrerrd/or Contractor) (Signed)---- &"✓�/--------'G�° -� --- - - ----------- -- --- --- - ------------ - -------------- --- -------------- - -- ------- ------ ---- - - -------------- plan, - ----- - 1.a B �/¢ E ---------------------------------(Title) . (Plot plan, showing size of lot, location of st to in relation to wells, buildings, etc., can be placed on reverse side]. + FOR DEPARTMENT USE ONLY DATE �s� ------------------------- ,APPLICATION-ACCEPTED BY Com. � o REVIEWEDBY--- ----------- ----- -- -- - - - ------ ----- ---------------------- - ---- - ----------------•-- ----------------- DATE---- -------- ---------------------------------•- 1,14 BUILDINGPERMIT, ISSUED------------------------------------------------------------------------------------------------------ DATE_.--------------------------------------------- . r Alterations and/Or recommendations:--- --��-�--�� - ��y� ��---°�.--------4:--= --------- -------r--- --•---- - ----`-- ---- ------ ---------- •----- = = ------- „ R,. ! 0401 FINAL INSPECTION BY--------- ` ------------- Date-------- � ------ ----_---- ----------------------- �.SAN JOAQUIN LOCAL HEALTH DISTRICT A� ; 1601 E.Hazelton Ave. + r 300 West Oak Street 124 Sycamore Street 205 West 9th Street ,V ,� '"�todi,California ; x Manteca,California Tracy,California Stockton,California 1 ' a � :y .�, q, ,, a F.RCO. ! 1.v.._ A