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FOR OFFICE USE: i - - � ----------_ro_= _ Permit No. . tZ._Th---- - -=--------- APPLICATION AOR4NITATION PERMIT / ------------------ ------- (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 applicationis made in compliance with County Oinan No. 549. Ar JOB ADDRESS AN LQCATIC,QN.-4f J5 -�--- ----`- ----- ------ - -------- --------------- Own is Name____-___ �Jl f_t e � Phone------------------------------------ Address. � � - ---------- --------------------------- ----------- - ---- ------- Contractor's Na i � �g-"- ----- ---- Phone � � 1 Other Installation will serve: Residence partment Hou ❑ Commercial ❑ Trailer Court ❑ Mote`❑ * ❑ Number of living units: __#"__- Number of bedrooms _�-_ Number of baths ___1--__ Lot size -_�r-__A__�____- -- ------ Water Supply: Public system a---community system [:1Private E] Depth to Water Table ,l4ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [I Adobe [ ardpan ❑ Previous Application Made: (if yes,date- _______---___._) No E] New Construction:,Yes ElNo FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tank or cesspool pi rmitted,if-public sewer is available within 200 fee+.) l +Fra o t pn-- __-- -- Septic Tank: Distance from nearest elllA(�'L�__Distan rel ------___. --- Material ____ ____ _ __________ ��yy No. of compartments--�--------`----_F_Sii _ _ ��;-�•---Liqu:d depth-..b__si+ "--Capacity-'_- V pisposaI Field: Distance from nearest well�P�73 ._Distance from foundat on._ -�______.Distance to nearest lot line_____ Number of linesr_�__-.- ___ -t_ Length of each line____ _Q_f_ ��- Width of trench---A----------------- -_______ Type of filter miter. _ Depth of filter material_""" ?_ .......Total length________________"_-�?"Q--------`._ Distance from foundation____ Distant to nearest lo} I' e_---- -_-_ .Seeps e Pit: Distance to nearest weILNQfte_ 0.1 r Number of pits.!-1___-_____-_____-Lining mate'riaL� r.......Size: Diameter__3_'�--------- Depth..Z_t�________"_"_"-_____ i `1— I , Cesspool: 1 Distance from nearest well________---w---Distance-from foundation... __-__-_._.Lining material_______________"________-______ -. i ❑ l Size: Diameter__}*=- ------------------ ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. - ~f :Distance from nearest building Privy: i Distance from neares?.,well----------------------------------------------- 9----- -: --------------------------- ❑ Distance to`nearrest'klot line------.___-------------------------- ------------------------------------------- ro Remodelin and/or re airin descri e : B - ------;- � ------------------------------------------------------- 9 � p � g ( b � �%'�/ ___________"_______________________________________-_-_____ _______-."_________________________________________________________________________________________________________________________________________________ I _____________________________-__.______--___-____-_______________________________--________________________ ___________-___-__________________________-_____________.------------------------------------------------------- -- I hereby certify Ahave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State•laws,wrules and regulations of the San Joaquin Local Health District. Si ned _t lay 9 viy4t. k Contractors 11 [ g 1 TATI1�""Sl^RCI'ICS-------------------------------------jells, ---- 2915 E.Miner Ave_, •_Hfl_s_'384i - ---------(Title)----------------------------------- ---- ------------------------ By:--I (Plot plan, showing size of lot, location of system in relation to buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEP.7ED:�BY------ __ f- DATE I'2-� REVIEWED BY--- ----- -i r ---------- DATE---------- ------------ BUILDINGPERMIT ISSUED-------------I = ---- DATE----------------------------- ---------------------- -------- I Alterations and/or recommendations: s ----------------------------------------------------------- Ii ---------------•-------------------------------•----- -•----------------------------------•-------- -------------------- -------------------------------------------------------------------------------------------------- 1__..,uv....... .yam, . ..�..�e...-.rf-**4 -------- ----------11-- ------------------=-- ----------------------------------------------------------------------------------------------------- t ,. ; ------------------- ------------ -------- --s-------------------------------------.--------------------------------___--------------------------------------------------- FINAL INSPECTION BY--------------t --- Date---- - -""--� "� /-------- - - - -'-.--- --- " -- -- ----------------- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California.— I. •