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FOR OFFICE USE: <br /> 0, <br /> 6 <br /> Permit No.APPLICATION6R S NITATI N PERIT <br /> Complete in Dupillicato <br /> .... ..............z.......... ...... 4j ( ) Date Issued t:_.'./a S <br /> This <br /> .....r­This Permit Expires 1 Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This application is made in compliance,with County Ordinance No. 549. -.030-Q I <br /> JOB n . Ak Uj.iAd-ujaa.c(._...---.•------••------- <br /> ADDRESS AND LO cJ( !i� e <br /> l...7 . ..... ... <br /> CATION... <br /> Owner's Name..... 114."t-A.1ex........ ------------------------------------------ <br /> Phone---.......--- --------- <br /> Address_------- .......Sbny......i-.) ............ ....... .................-------------•-• ........................ <br /> Contractor's ..............­__................................................. ........... ..........._..... Phone... .................. <br /> 1 0 Other [ZAi6a <br /> L- -r <br /> Installation will serve: 'Residence 0 Apartmej House 0 Commercial., Trailer Court 0 Motel <br /> IS owev:% <br /> Number 94 living units: ..._.... Numberof 4inwil000lies 5 Lot size ft._AA?0..br—t.e:91--------­=-­------ <br /> t <br /> Water Supply: Public system 0 Community system 0 Private Depth to Water Table Akilt <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam.0 Clay Loam E] Clayo Adobe Hard-pan 0 <br /> Previous Application Made: (if yes,date...... --------I No [& New Construction: Yes [& No ❑ FHA/VA:Yes [3 No C& <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well..,50......Distance from foundation.__16-L ...Ma <br /> Sepfic Tank; I <br /> No. of compartments----...............i...... ......Liquid de t p�11-_6_'74- <br /> undation-.j..0..........Distance to nearest lot <br /> Dislc�sal Field: Distance from nearest well-S.O........Distance from fo 'ench _36.*.. .............. <br /> Number of lines..L­5..............._._Length JeachIine------- -----Width of h ...... <br /> -Depth of�filter material... <br /> Type.cif filter maierialely.... .....Total <br /> I lot line... <br /> Seepage Pit: Distance to nearest well-----k.(!k0-1__....DistanceNrorn fjundation.....16­---.-Sistance to nearest <br /> %---Number,.Of pits-21"Z------------Lining materiaL%P,!._t-OCIL—Size: DiameterAt---X.10_I------Depth----IA'­.................... <br /> .......................... <br /> cesspoo•l.__!'10i�tance fromnearest well.................Distancajjicom foundation................._Lining material...... <br /> Size: Diameter----rf---------_--___........-Depth--------.... .............­­­------ Liquid Capacity....-------.............. <br /> El I I f--- r4_`1 .......... <br /> Privy! Distance,from'nearest well...................-_.._._..:.:.__......:_'.Distance. irom nearest building__.......... <br /> .................... <br /> 13 Distancelf6 neam4s+ lot line-------........----___...Q.:._----_....... ..................................... <br /> I I " , it - I . lem, t. <br /> Remodefigg anal/ r repair1n1-'_1(JCribe):........'------------•-----...------------_....------••---------•. ........................_.............--------------_..----Y-- <br /> t . ............ ........ ........... <br /> .................. ........ ..... .................................................­................... <br /> 7 -----.........__.................................­­­­_4---------- <br /> ............. ................................................. <br /> .................­_: --------........................................................ ........................... ...... ........ <br /> ..........---------------- <br /> certify that have''prepared this application arid that the work will be done in accordance with San Joaquin Count <br /> y,.%hoe WIIII"" e <br /> a inlim s, fate laws and rules and regulations OF the San Joaquin Local Health District. <br /> 7 <br /> I_ 4 ....................................(Owner and/or ConfractorIf <br /> ISigned)--------- . (? ­1............................................................. <br /> ----------------- ----------- ----- .. ...... <br /> By..................... -----------­_­­............................. ---(Title)------------- <br /> jplof plan, showing size of.lot, location of system in relation to welts, buildings..etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> FAPP6CATION ACCEPTED BY_..... -- -_---::�!,....... ............ ............. ......... <br /> 7 ­.......... DATE..-.....:.........- ------------------------ <br /> -AEVIEWED BY.---------_------------- ...................................................................­.............. DATE........ .........1/1 <br /> ­...... <br /> PERMIT ISSUED........... . ..... <br /> ING P ........ --------- <br /> I_... ...... <br /> U LD -------- , <br /> PAIt'eir;tions and/or r*c*rnmendes,­,­.',I�-/:?-.0. Vwz? <br /> ........... -- ------- .........----.. .......... .......................... <br /> I........ ...........__........ ..... .... <br /> .......................................... <br /> .............. ...................... ..............-----:------ ................................................-------------.......................................................... <br /> ............................ ........................................ .......... <br /> FINAL INSPECTION BY:....V 7 t.... =-�------ I> Date------ <br /> ..................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 K.Wastiltat,AIia. 300 Weel Oak Stmt 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> fedi,California Manteca,California Tracy,California <br />