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- ----- -------------------- - - - <br /> _ ----- --------------_------- -------- - . r.,tiICATION &6SAIATION K .W"f Permit No. ._l/.-f_-:..IZZ <br /> a-- - -------------------------- --- -- (Complete-in Duplicate) <br /> Date Issued <br /> ___-- - ---__.__._.__. This Permit Expires 1 Year From Date Issued <br /> . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A LOCATION. S ���' ✓ r` � <br /> -----.... ' ----- ---- -��-------V'=�`-- - -�f�1-_-------k�e—rim-z*�-?�------------------------•----- <br /> Owner's Name._ <br /> = -� ----- Phone------------------------------------ <br /> ... <br /> ----- ---------- - <br /> Address / _ 3r l .�f.'_-- ------ -- -------------------------------------•----- <br /> Contractor's Name �lcrkc.Q. . r �• ------- ------- -- -- ---------------/--- -------------------- Phone----------•--•-•----•-•----------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: __ _- Number of bedrooms __ ... Number of baths -------- Lot size _._-. ... __--- _.. ---- ------- ___. ........... . ... <br /> Water Supply: Public system E ' Community system ❑ Private ❑ Depth to Water Table _..._. - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [[Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_ _ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--___-_-- -------Distance from foundation___________________Material _--- ---_--.-_- <br /> ❑ No. of compartments-.------------------------Size-----.---------..--- -----------Liquid depth----.-.-- ------ ------- Capacity-------_-------------- <br /> Disposal Field: Distance from nearest well../4PA!__,0.'Distance from foundation--- C---._.-_...Distance to nearest lot line..J....._.._... <br /> Q' Number of lines ------------f.___.______________Length of each line.. .174fl______.............Width of trench. ,,Z..i._________.__________... <br /> Type of filter material-------- Depth of filter mater % <br /> ial_____. .._____._T _. <br /> Total length _. ------------------------------- <br /> r <br /> t: Distance to nearest well.._,/.OQ._._f--_Distance from foundation----/s7.i_._.___Distance to nearest lot line._I <br /> ❑ Number of pits._. ..___..........Lining material.--_SIZ Size: Dep <br /> ---�--�5-._ to---Z -- ----------- -- <br /> Cesspool: Distance from nearest well ................Distance from foundation--------------.._ ..Lining material---------..-______..____.__--__-.-___ <br /> ❑ Size: Diameter -- --------•---------------- ---.Depth---------------------------------------- ---------Liquid Capacity----------_--------- -----gals. <br /> Privy: Distance from nearest well-.._.._-_._-..__.....................__.....Distance from nearest building------ _---__.-_----________-_-..--.__ <br /> ❑ Distance to nearest lot line -- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairi )de crib ):--- <br /> --- -- - <br /> ----------------------------- c ---------------------•-•-•---------------•-----•-------------•- <br /> -- - -- - -- - <br /> -----------•------ - --------------------------•-----------------------------------------------------------------------------------------------------------•----------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stategllas,.-11 <br /> d rules and re ulat' sof the San Joaquin Local Health District. <br /> (Signed)----------- ---- ----- -- - -- -- -- ----4,elatio <br /> ---------------- - .-----•----------------•--------- IIwner and/or Contractor) <br /> BY -- --- - -------------------------------------(Title)------------ ---- ------ ------------ <br /> (Plot plan, showing size of lot, location of sys+e iells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--_ -- ----------------- ------- ------------ DATE . , ------------- ---- <br /> REVIEWED <br /> - -REVIEWED BY--------------------------------------- ------- --- ----------------------- -- -------- -- --------- ---------- ----- DATE----------------- ------ <br /> BUILDINGPERMIT ISSUED-------- - ----------------------------------------------------------------- ------ ----------- - DATE--------------------------- --------------------------------- <br /> Alterationsand/or recommendations----------------------------------------------- --------------- --------------------------------- •---------•-•--------_-----•-•---------------------•------- <br /> --•--------- ------------ - -------- ----------------•-------•------------------ -----------------------•--- ------••----•--------------•--........._..................-•-------------------------------•-•........._....... <br /> — -------------------------------------------------------------------- ------------------------------------------------------ -------------------------------------------------------•-------------------------------------- <br /> -­-------------­.... <br /> ------------------------------=-----•--. ----- -----. -- ---- -- -------------- --- ------------------ ----------------------------------------------------------- --------- ---- ---------------------------- <br /> ------------------ ----- ----------- -.....- --- ----------.. _ ---------------------------------- - --- -------------------------------------- ---------------------------- --------------------------•---- <br /> FINAL INSPECTION ------ <br /> .....__. Date- ------ -- --- -- -------------- ----- --------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi California Manteca, California Tracy, California <br /> E.H.9 2M 1-67 Vangaard Press <br />