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T. FOR OFFICE USE: ___________ ------------ ---------------------- -------- APPLICATION FOR.UNITATION PERMIT Permit No. _- , ------ -- -- -----:---- -J ------------------------- -----_--------- '(Compute in-Duplicatel - f .--..-" This Permit Expires 1 .Year From Date Issued Date Issued �_—�-��- 2.zz_ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work.-herein described. .. ��Tsrplicaf ion is de in cqmpjiance with County Q-rdinanceQNo.s 49._ �y� 'r I l�'�1�i'7 �LP C ! Ml i� � r JOB ADDRESS AND LOC4101 [s.J-�f3,EG1 -_::.�c "n'------------- 1 �w a� f - Q -1 Q _pis .... IRNr: L .wa:.-�-w-a-- ----"-t` i - Phone-_-, --Owner's Name------------- �------- Address-- --Address----- - - _ - iI Contractor's Name____lNE • ---•----------------------------- ---- Phone-----•----- - ----------- --------- ---------------- ---------- -- - ------------------•- Ins+alla+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms~______ Number of baths -!_.-._ Lot size -- ____ R_ _'__________________ I --- Water Supply: Public system '❑ Community syst m ❑ Private Depth to Water Table_ -------- ft. 'Characfer of soil to a depth of 3 feet: Sand-P!r Sand-P! Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ . Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote.__.____._,___..__.) No -® New Construction: Yes 9wo ❑ FHA/VA: Yeses No [] E TYPE OF INSTALLATION AND SPECIFICATIONS: F --� (Ncrsepfic�tank_or cess po 1 permit 1ff,public sewer is available within 200 feet.)' -i.__ Septic T nk: Distance from nearest well___.SQ-_Dist ancefromrfou�ndation` r� -------Mater'aICJ/1!< - -T -___-- p„ [' No. ofeamartments --. -------------Size_: X1Q__ -- -----Liquid depth---��'7r-----_Capacity-._� QC7-- Disposal Field: s+anc oA nea es+fwell____50..__Distance'from foundation___ line---- D- d [_�___._-_-DDistance to nearest lot ___...__. Number of lines.---------3.. .x.T,.---------Length of'each line___`. 1!•-. 5-Width of -_��_-- • ri Type of filter mate T, of„filter material___- ---------Total length_----------!6-5_------------------ -_. Seepage Pit: Distance to nearest.well ,c _.Distance from ❑ t foundation_ ---------------Distance to nearest lot line__-_-- _____-_Numberof pits_ ._._-___-- --- -Liningmater'al - - r. -- Diameter------------- ---------Depth---- -------------------------- y--- tancCT -. Cesspool: Distance from nearest well_-___:__-_--__-Distance from foundation____________________Lining material-------...___.----______.-___________. t7 ❑ �' Size: Diameter--- _-- .Depth---------- ---1 "k._ --- Li uid Ca Capacity�;,; - - -- - ----- - - : G p ---- -----------------gals -- Y- Prlvy: Distance from nearest we11 ° .Distance from nearest building- -------------------------------------- --- f ------- - - i ----- ---- ❑ 3 _.y _____..._-_. --- -------------------`--------------------------""- -------------------------- Remodeling .•----------------- ' Distance to nearest lot line_.___ g / " � pf g ( ) I r ----------------- ------- � ! EQ.__l1,r!...TF�fS1 — T� " Remodelin and or,rre afrm (describe):•_ . �-_ b I�EpRp !✓t V�tw1- .1._ ll:-----&U-T �rIM f� pl- Epp . -------A---------3----- r oAoa+r►� DIInIr r t.�.n[� A.r------0 NEU- --------- -------------------------- -------------------------- i I hereby certify the+`Iphave,prepared this.application and fl apf, he work will be done in accordance with San Joaquin County .ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.' , (Signed)------- _- 1 (Owner an # ----' ------ - --- Contractor) t -. — Tale r on rat By• _ _ - � � ------ -------- ---- 0 or ��.�-->- �w� ,..�..- �,:--'—"mow.--�--ear.-�-�-•��-��-�_- --- -1�..� - -- --- (Plot pla 4- �_ ..�. . -- ILL, of to+, location of system in relation to wells, buildings, a+c., can be placed on reverse side]. � .._ � .. . FOR;DEPARTMENT^tJSE'ONLY APPLICATION ACCEPTED SY--- --0 .---------------------- ---------------------------------- DATE----- ------ '-,✓.7 REVIEWEDBY-------------------------------------------- -------------------------------:- ------- -------------------------------------- DATE --------- BUILDING PERMIT ISSUED------------------------------- - -------------------------- ---------------------------- --------------------------------------------------- DATE € Alterations and/or. recommendations: _________ --------- _________ ._. _ • ----------------------•------------------------- ---------------------------------------- -------- -------------------- - ----------------- ----------------- ----------------------------- s , 'L FINAL INSPEC >7_ - -------- • - ------ Date-------- - - '.f+/-..- ... 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 41 1 Stockton,California. Lodi,California Maritecar California iTracy,California