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s y ivr< vrriL,C UJC? �,, i --------------------------------------------------------- -------------------- - --------------------------- -- APPLICATION FQF -J&�rNITATION PERMIT Permit No. . -------- ------------------------------------- (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 herein described. This application is made in co iance with County Ordinance No, 549. Zdg- (?c{�-30 MfC� w JOB ADDRESS AND LOCA ION------ --C c.D-f-------Av...---- ---- -----v-0-0--------E-----OF=------COTfi6�/� - --------------- Owner's Name ��t�) A ( -"------------ -------------------------- Phone Address___ / __.:... _ E, --------FL_ D------- •---------- '�- _ - Contractor's Name Q ---- ------------------------------------------ !Phone-----------------'-..------------- .�.. Installation will serve: Residence (Apartment House ❑ Commercial ,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms _ Lot size -___ - X-79----_-- � Number of baths - ��6- ,�,-------------------- Water ---- ------------ Water Supply: Public system ❑ Community system ❑ Private R2-IJepth to Water Table 12-4t. Character of soil to a depth of 3 feet: Sand p [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date '.__ --.-) No New Construction: Yes ��o ❑ FHA/VA: Yes [-1� No ❑ --TYPE-`OF`1NSTA-LiTATION'AND`SPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) " 00 Septic T k: Distance from nearest wells-� - ____Distance from foundatiori__:_l '" 11 r� s �^ , ---------.Mate sal--- No. of compartments _----------Size__1 x._ �x --- depth } ` Disposal Field: Distance from nearest well:_15- ---_Distance from founidation-_-__/0-___--_Distancelito nearest lot line __-_-_-__-{ ►: Number of lines--------- ------ -."----------Length of each line-_90-40 :-_j0.Width of trench-------- y_`F_ ___________ m l i Type of filter material__FQ_'��----Depfih of filter material^�..��_-tc-----"'"' Total lengfih_s __-_-__-.r_�___�__©_____________-__ Seepage Pit: Distance to nearest well----.___1-.-(_-Distance from foundation--------'_'' :_._.Distance;to nearest lot line--------------- j ❑ Number of pits-------_' -sLinrng 'material---------- , � ------.Size: Diameter-------- -------=�- Depth---------------------------------• C� � Cesspool: Distance from nearest well __-__-____--pistance from foundation---.---__-___ Lining material_________________________________-_- - if ❑ Size: Diameter---------------- -- ----------Depth--------------------------------- - ----------------Liquid Capacity----------------------------gals. s Privy: Distance from nearest wellJ--- ------------------------------ ---------------Distance from nearest building-------------- ___- ❑ Distance to nearest lot line_, ` - +. --------------------------------- --------- Remodeling and/or repairing (describe)______ __________________ = ----------------------- + ------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------------------------------------------------------------------=--I-----------•---------------------------------------•------------------ ------------------------------------------------------------ M I hereby certify that I have prepared this°epplication.and.,that:the work viill;be done"ia accordance Joaquin County with'San N ordinances, State laws, and rules and regulations„of the San Joaquin Local Health District. I _(Signed)--- -.-`- orContractor) R ---T-�$ � �-----�------------ -- -fit _ - - _ Y= --- ------ - «` ...�. .(Ti e Owner an (Plot plan, showing size of lot, location of systerrl.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------~Ti-� � -------------------------------------------------------------------- DATE-------3_` ��._ .C4-6------------------REVIEWED BY------------------------------------- -- ----- -------------------------------- ---------------------------------------- DATE BUILDING PERMIT ISSUED----- ----------- ---------------------------------------------------------------- ------------------ DATE Alterations and/or recommen ations: ------------- ----------------------------------------------------------------- ----------------------------- ---`66-------��VSEGTEp= ET�/� 4 N SFr-tC, 4 �.._Nl ----------- ---------------------------------------------• ------------------------ ------------------------------------------------------------------------------------------T'f-R--a' . ------ -----------------------------------I----------------------------------------------=---------------------------------------------------------------------------- ---------------------- ---------------------- - - --------------------- --------------------------- ------ ----------------------------- ------------------------------- ------------------------------ - FINAL INSPECTION B ._.. ------ -----� -- - ---- Date---------- '9 �9-�0� - ---- `---------------- �l SA JOAQUIN LOCAs. HEALTH DISTRICT 1601 E.Haselton Ave. 300 Wer�OOk S!reet 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,Califon id- Manteca,California Tracy,California F.RCq.