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FOR OFFICE USE: v. ------- ---------------- ------------------------------- -APPLICATION Ftj-R'"gA�IITATION PERMIT Permit No. ................... .... ------------------ -- ------- ---- --- - - -------- - - (Complete in Duplicate) Date issued -- ....................................................... t This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct al-Winstall the work herein described. This application is made in compC nce with County Ordinance No. 549. 5r JOB ADDRESS AND LO TI N----- ._RR E ERIC_KS----------lZi-PL4--------�©_._. �.Sl- I'S. � �C�F� -----------�,.- Owner's Name------••--------- OF.....---•--..A I=K JE -------------•----------- ---------IF'A------------ ---- Phone-----•-----•-=------------------•--- Address.....•........R-T- --;;?;�--+.. 'Ok-------Y-2-7-------.. -----------------•------------- --------------t— ..4:,.. . Contractor's Name-----C - 'E ----------- -------------------------- .-_ Phone.--------- ------•----- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ } Number of living units: --I-.--- Number of bedrooms-a.- Number of baths ---L Lot size --_A_(_A_E9C_jE:-------------------------- Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ S_ ft. Character of soil to a depth of 3 feet- Sand [!Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.______._,___.._-_) No&'� New Construction: Yes ❑ No 2- 1FHA/VA: Yes ❑ No 2-- TYPE OF INSTALLATION AND SPECIFICATIONS: No-se c fank:or-cess oolP ermittedTif- ublic-sewer-is-available-within:200-feet: — -•�- ( ti PP P ) Se tic T nk: Distance from nearest welL__SO-_---Distance from foundation-l0-----------_Materi i__Co� R-ET�--------------- 7� No. of compartments-_...7�.._-_--.---.Size-___ ._x_�iquid depth-----Y�Z_----..Capacity----- Disposal .Capacity_-_-_ p 4� Field: Distance from nearest well.-. _C _..._Distance from foundation-----10-------.Distance to nearest lot line--- ---------- bis osal F Number of lines__________ ----------------------Length of each line-.----- Width of trench_---2 �__-_.._ __..-_-i 1 r - Type of filter material--- C ---Depth of filter material__--/`_______..___Total length---------- cv -:___- .-- i Seepage Pit: Distance to nearest well------------------_--Distance from foundation........_........___.Distance to nearest lot line-.----_.--------- ~' ❑ Number of pits----------- ----------Lining.material _.__Size: Diameter`_J_A........ Depth_______________________________ Cesspool: Distance from nearest Distance.from foundation__________________ Lining kn t r material- __.__._-___.------.-._---_-____.- Size: iameter------- -------------------" Rt L-quid Capacity-.--.--,❑ t1- _° s . i gals. 7 � -'_ Distance from nearest building Privy: : Distance from nearest well---- - '-:-- �..___s. - 9-----� - ----------------"------.. a l it -• �� t , ❑ t M Distance to nearest lot line.-. " Remodeling and/or repairing 1dLcribe :----- RPI'T 171-0E r4------- ------ 'ST # # - ------------------------I--------- s x l ________________________________________________ ________________________________________________________________________________________________ ______ 1 _ _ I hereby certify that I hive prepared this application and that the work will be done In?accorda ce with`San Joaquin County ordinances State laws, and rules and regulations of the San Joaquin Local Health District. # S (Signed)- ' __ ____ _____________.:_ .-..(Owner and/or Contractor - a / ) �_�.. --------------------- ------------------------_:- ---- - .� ------ -------------- (Title)•---- -- � -- --- -- [Plof pl „, showing size of lot, locafion o system to relation to wells, buildings, etc., can be placed on reverse'slde). f FOR DEPARTMENT USE ONLY s ' APPLICATION ACCEPTED BY- - _tt_ TJ9------------- --------------- -- ---------------------------------------- DATE----------i� REVIEWEDBY------ ------------------------- -------- ------------------------ --------------------------------------------------------1- DATE-------- f" " ---.-- ------------------------------------ BUILDING PERMIT ISSUED----------------- ----------------------------------------------------------------------------------- DATE-------------------------f---------------------------------- AIferaf Ions and/&r`recommendi flans: ------ ---- ----- -------------------•---------------------------------------------------------------- --------------I----------------------------- --------------------------------------------------•---• ------ ---------------- ------------- ---------- - ------ fi -------------------- -------- ---- ------- ........"...... ...... =------- ------ - " _- " " • "-"f --"-•-------" -----" FINAL iNSPEGT N 6 - .._-- ;"- Date.------.---- � ''/ ---� _.-'--"- '"�'` � --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California