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"h ............. ..... ................... .............. ......... ...... .......................... APPLICATIONIGANITATION PERMIT Permit No. ................................................... . (Complete in Duplicate) Date Issued ......... .................................. ... ..... ... This Permit Exoires I Year From Date Issued . F/ de to t— ?--go—a;o Applicafion is hereby me he San Joaquin Local Health District for-a�permit to construct and install the wok herein described. This application is made in compliant with County Ordinance No. 549. JOB ADDRESS AND LOCATION'.-it j4_.... .5:;..;. . o_ . - .14,v ... Owner's Name-----........... Pk-. ...........------............. ....................................................... Phone-,.. ..................... Address------.iircii5a,4,694V ........................................................................ .................. X R4 Contractor's Name. ..............................................--------------------. Phona- Installation will S!"W Residence lj�r Apartment House [3 Commercial [:] Trailer Court El Motel CI Other [3 Number of living units: Number of bedrooms---?- -.Number of baths 2__5`6of size*_196?eAS_<...........I................... Water Supply: Public system ❑ Community system 0 Private VDepth to Water Table ........ ft, Character of sail to a depth of 3 feet: Sand IIKGraviiil [] S dy Loam[] Clay Loam L] Clay[j Adobe 0 . Hardpan 0 Previous Application Made: (if yes,dote.......... .........) No �7 NewConstruction': Yes F� N, [3 PHA/VA: Yes [3 No TYPE OF INSTALLATION AND SPECIFICATIONS: (Noseptictank or cesspool permiffed--if public-sewer Is available wifhin-200 feet:) Septic jeik: Distance from nearest well...410----- Distance from foundation ..met rial.... ............ ..:W I-0 p�h .. .. No. of compartments.......2---------- "Slza.�� '1.0.....Liqu"id*de...... .............Capac!ty../),.-.,k-l!.f;..... Dis ield: Distance from nearest well... 'Distance from foundation... to nearest-lot 111DI-L--- Pr Number of lines....... Length of*each IA...........:.................•Width of trench...... ? jc...%.........Total .......Totelr Type of filter material.. 1�6r_'A A41.-Dopfti of filter material......f. ...... .................... Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line_..-... ... F1 Number of pits......................Lining material.......................Size: Diameter....... ........Depth.............. - ------- Cesspool: Distanc; from nearest well.................Distance from'foundation__W..........Lining material...__........-- , 0 Size: Diameter......................................Depth............:......- -------_.........-_....Liquid Capacity....................-----gals. Privy: Distance from nearest well..-_-...-.............-........__...._...-_...Distance from lificarelif building._............................._....... Distance to nearest lot line---:...•------------ . .._......o. ................❑ ............................................................... Remodeling and/or repairing (describe):..............!l....................... ...............................................--------------------------------- ........................................................................................I.............................................................I........ ------- ---•--........................` -..... ....................................................... ............. ------------------------------- -------------- ------- ..��U7:-----...1..----------'--...................... ......................................--v------------------- ------ --....... I hereby certify that (have prepared this application and,tha+ the work will be done in accordance with San Joaquin County ------------*----------------------------- i ordinances, State laws, d les and r lafions of the an ci.aquin Local Health District. . ... ......... . (Signed)......... ........ -------[------------------------------_-_------- ---- ....... (Owner and/o Contractor) (Signed).......... . . ----•........._.........------- ........... > ....�,.k,................... e We ..............(Title)...... . IP[of plan, showing site lot, location of Si4arn"in relation to buildings,`etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY........ ........_T.T. .....................��, ........._ DATE.........g.,,je REVIEWEDBY-----....--'-----....... .....................................I........ .............................. ............ DATE..------.......... BUILDING PERMIT ISSUED..-... ........................................ --.....:..:.._....-•--------•--------y.....---- DATE............................ Alterafi ions and/or recommendations:.........__...................:...................................................................... .' ........................... ................. --------------------------------------I------------------------------------------- ...................1................................................................................................. ...................... ................................ .......... ....... ........ - ---------------------**-------------- .....................**...........*....... ------ .......................... ................................... .............I........�............ ........... .......... K.................................................................................. . . ......... FINAL INSP &TIbs ....... Date. ............ E---- iz - ------ �.. . I I ............ t. ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Marlton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California todi,Colifomia 1,i California Tracy,California "Ev,Sea .-So 3. 3=63 I.P.Ca.