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} FOR OFFICE USE: 4 -----------------------------------------------' - 4 S :�. APPLICATION FOR SAN TA~�ION PERM17 Permit No. __ �, --•--- -_-- ---------------q :(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 install the work rein des4rked. ti u This applicatiori.is made_1 in compliance with County Ordinance No: 549. N = �2 1 -- 030�t� , 4 f S .. O �:..�s=- n�`�ocATl"oN..�.�-D-�----x-�: __._.._R#�----°__----1-2��-------�--------- F ---P00 _JJOBADDRESS A' fes[ _r Owners Name------ F { R ------ - - 6 r\_� =-----------'----------------- Phone------------------------------------ Address--------------------------------V2-1--:!�L-�----.-•- 6D�- --- '� ----------- Contractor's Name---------OW—ALF--1 - - ------------------ ------------------------------=------------------- --- --------- Phone----------------------------------• 1 Installation will serve: Residence ®-partment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: --/----- Number of bedrooms -3__ Number of baths �_ Lot size __1.3.3_ X ---------- Water Supply: Public system ❑ Community system ❑ Private 2r--Depth to Water Table3.�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam } lay ❑ Adobe❑ Hardpan B— Previous Application Made: Ilf yes,date--------- } No New Construction: Yes Er o ❑ FHA/VA: Yes.�,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - :-(No septic#ank-or tesspriol-permitted-if public sewer'is available-within=200 feet.)� 1 Septic Tank: Distance from nearest well .0 _Distanncce from foundafion__.rl--__ _- Mat rial__.(fQfDCRfU_��... No. of compartments_____ 2— _ _ --Liquid depth. _ -------Capacity....I,�0 Q Disposalwell 1 e Field: Distance from nearest well.--;5<:D..-Dist�ce from foundation__.-10-..____-Distance to nearest lot line______._... Number of lines--_------/----------------- ----Length of"each line..- �?Z5) ` .- --.i-----.Width of trench------- ..op--------------- Type of filter material---RVt-:K.._-:Depth of filter,materiaL__/_7------------Total length_--------------9�1---_._--_----------- Seepage Pit: Distance to nearest well...../ ri_-__-Distance from founds,tion____ -------.Distance to nearest lot (/ Number of pits-------- Lining material._RL-?C�---Size: Diameter.'- -Cesspool: Cesspool; Distance from nearest well._'--___-i--.-.-_Distance from foundation_.______'_,,_-_---_.Linin materia!_______________________________,.___ x_ ❑ Size: Diameter----------------------- -----------Depth -=` , • - Liquid Capacity---------------------------gals. j] Distance to nearest lot line,__,___________________________________ _ _ Distance fro nearest building_____________ ..___,__ .._... Priv Disfance from nearest well______._'-----_ Remodeling and/or repairing (describe):---------- -'------------------ ------ -------------------- ----------------------- ------------------------------------------•----- ------ f _. ----- ----------------------------------------------------_--.----__._---_-____-__-----_-__-_-.----_--.--_-.--...-.---_____-__----_--.---------_--__-------_--_-_----__----_-._.--_______-_---_ nt #- ___________________________ ` __-_ - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance,with San Joaquin County ordinances, Stat laws, and rules and regulati ns f the San Joaquin Local Health District. {Si reed ------ -------------------------------------------- Owner and/or Contractor) 9 --------------------------- -----•-------------__------------------ - -. - ----- - --------- (Plot ---- - -�;... ----=-----=--_=-_--_--�_-...,r.------- - .{Title)-- --.... _ - (Plot plan, showing-size of.lot, location of,system in relation to wells, buildings,,etc`,,can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY__ y-�--t._R_0� ------------ ------------ ---`------------------------------------- DATE------ T� ^.1�- ----------------- dDATE---.---- - ----------------------------------------------- BUILDING - REVIEWED BY---------------------------------"-----•--------------------- - ------------------------------------------------------- -- - - -- -- ------------------------------ .ti BUILDING PERMIT ISSUED----------------- -------------------------------- ---------- ---------------------------------- DATE--------- ------------------------ ----------------------- Alterationsand/or recommendations-----------------------------------------------------------------------------------------------•--------------------------------------------------------------- i k. ---- . �.. a q2` 5 - - FINAL INSPEC SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 208 Wast 91h rStreet _ Stockton,California Lodi,California Manteca,California ='Tracy,California