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-FOIA OFF! E E ----------I ---- - � � i, r1�PE T - , 1 ` - APPLICATION,.� ---------- (Complete - - -- mit No .�✓� r}� ------------------- ---- ------------- --------- Com lets en,Du hcete // / - ( P P ��€..' - -Date Issued _._.._-- -.l..�_..fo� This Permit Ex •fires 1 Year From Date' ed Application is hereby madeito the San Joaquin Local Health District for ah permit to construct a�i'd install the work herein;described. I This application is made in compliance with County Ordinance No. 549. ^ JOB ADDRESS AND LOCATION----------------427___bS`Q_Z4_th---Todd. X -_Gaie----------------•--•---------------- --•--------------------- -------------------•----- Owner's Name---------------G']-- : ��1n_.4�r�dpsephE7ze. Cuff[x11 - Pl'loneHO....4--$021.. 11 , Address-------------- --------427__�S:QM-trh---G-QJ-17.0n----09: _= t ------ -------------------------------------- ---------------------------------------------------------------------- • 3 3------------- --------Contractor's Name--- Tr ame �t ' ` iank: "eir'VZs - IT2Cs. PhoneH ..... ,• Installation will serve: Residence.' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑i Other ❑ .r Number of•living unit's: __�_:_ Number of bedrooms --- Number of baths ---I--- Lot size __ ._ __.Z ............________________________ �r 4 Ver'Sypply; .Publicsystem u Community. system!.❑ Private E] .Depth to Water Table .45- ft. r Character of sod to a depth of 3 feet: Sand ❑ „Gravel ❑l Sandy Loatn ❑ Clay Loam ❑ Clay [3.-Ad66egy- Hardpan Previous Application Made� (lf.yes;date.__ - No-U New Con`strucfion: Yes [j., No•a" FHA/VA: Yes ❑. -No,� Application a. TYE OF INSTALL ND SPECIFICATIONS: Aspool permitted if-public sewer is available within 200 feet.) fVo septic tank or:-c - Se* Tank: DistancE from nearest well,__________ ____'.Distance from,foundation___________.___=--Material__________.___.__ ._---------------------------- p No: of compartments- :' Size Liquid depth--------------------------Capacity------------- ------- rl .11: Disposal Field: .'Distance :from�n_earest;well._.----.-1___,: Distance from foundation____________________Distance to nearest lot line____.-_...__....- 1 Number:lof lines:-----1-• ------------ ' ❑ ------==--Length of each fine-------•---------------•-----Width of french.-------------:-•-•------------•--- Type of filter material_=-A-----------------Depth of filter material------------------------ otal length---------.- ------------------------. - �� <' I !' i Seepage Pit: . Distance to nearest,well____no________-_Distance from foundation=___.�C=°__-._..pis�'nce to nearest lot Gne______5..______ Number of, pits_J--- ---=---------Loring material----7"aC ------Size Diameter----_-_...-- 25•-- +;• ma _33 -..__.Depth-____-' .- a _ . - --- . :..,�. '> - dpi Cesspool: Distance.fi6rn nearest well___XtQ__----_,Distance from foundation....10-1-------- material________________________.__________.." i - e K. r Sin s-t ang Size- Diameter----- ------------------- --.De th----•-------------=------------------------------- Liquid Capacity gals. Priv Distance f Privy: rom nearest,welL _ __. -:-1-------------------------------------I-.Distance from nearest building------------------------------_------------- " ]t Distance to nearest lot line-----`--------------------------71---------- ------------------------------------------ --------•------- t Remodeling and/or repairi descri a ClQ'db12 drain to cess 00� g [ b 1 ----------- �' ---------------- iM: .—. I ----- , . , ---------------------------------------- -- I' F i I herebycertify that I:�have prepared'Ais aplicati n and that the work will be,done in accordance with San Joaquin County ordinances, State laws, and rules and reg'ul'ations of the San J giiiii,�.Local Heal 'District, s ` ------ --------------(Owner and/or Contractor](Signed) ^� 1_iL__- - - '--- - -- ---- - - - - -- = ----- --=---- --(Tltle)_�Gen4' r1------------------------------ --- (Plot plan, showing' size of lot, location of s n rely 'o to wells,(buildings, etc., can be placed on reverse 4de): -�, - N r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... . . . �`1 : ---------------- ------ DATE------- F� 63 --------------------------- REVIEWEDBY 5'--------------------------------- -•- DATE--------------------• -------- -• -- BUILDING PERMIT ISSUEDk--------- ---------------- D_ATE ----------------- -- ---------------------••---•-- ------------- --------------- t ons ` Alterations and/or recommendati _ ' -- ---- - i - -- -- ---------------s--------------- ------- ---------------- - - -- ------- _ =r'------- ��f! ,cg INSPECTION BY:------------ Date-�-- ---------------- --------- --------------- ------------------------------- FINAL - -i� �.. SA JOA?UI L CAL HE* H DCSTRII �` 6 130 South American Stre 900 WasPej Creel 141 Sycamore SfFee4 ' ~�7� 405 West 9th Street *Zco � Stockton,California � � Lodi,California Manteca,California Tracy,California @9.8 REVIH EO FJ•38 P.P.0�.3M 6.60 I •