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FOR OFFICE USE: _ d . ---------- = �� -- - -- - -- ..-.._.. __ - R APPLICATION FOK.$AtUTATION PERMIT mit No. 4 vM • (Complete-in Duplicate), • '�ti -------------- --------------------`-3---___._._...-. ---- -- --- This permit Expires-1 Year From Date Issued ate Issued Applicationis hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein described. This application is'made in compliance with County Ordinance No. 549. r- . a ► Y £ *> k JOB AQDRESSA LOCATI N....CV. .__ -"-_ _-_ - _ �. " ------ ----------------------------- 0 --------- ------- . M :t : Owner's Name----- -- - - 4 h: ne P .�- lflQ 1 40 Address-.---- --3 � i f Contractor's Name -_. - ------------- ------ Phone.rr� f� : ,7" 3t I - y s Installation will serve: Residence,, Apartment House ❑ Commercial ,E].—Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms I`- Number of baths'J--.- Lot size ...�_.�/ --.�_ .Q........................_ t Water Supply: Public system Community system [IPrivate [] Depth fol Water Tabe 7,v— Character of soil to a depth'of 3 feet•' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay ❑ Adobe Hardpan ❑ Previous Application Made: ,Ilf yes,date----------------- I No New Construction: Yes ❑ No 3?� FHA/VA: Yes ❑ No Pr' � TYPE OF INSTALLATION AND SPECIFICATIONS: i No septic tank or cesspool permitted-if public sewer is available within 200 feet.)-r �' Ir Septic.Tank:,19 dot nce co from wel� A2�Distance.from,foundation.-/Fr7---- .... Material ..... ....... .. . .. _ ... E , P Size 3.X._T_7 K Liquid depth_'- _r` ------- Capacity.. W-Q Disposal.Field: Distance + --/O.i........D.- istance to nearest lot Iine...tS~-....-..... Numbenearest of lines.-; eIL�B-1(?�.-Distanceanon Length of each line . gp Width of v !r Type of:.filter material... _ . . Depth of filter material ....__�_g_......Total length----------7--. ------------------------ 1 4r .. - r ti / -Seepage Pit: Distance to nearest weIL. Pt?},�9C,..---Distanc"om undation-J-0__-.--___Distance to nearest lot line..._--_ ----- Number of, its_ j Linin material ---- Size: Diameter'-4. "_d --................. P C >=-------- g Cesspool: Distance from nearest well ................Distance from foundation... ..Lining material...... .-------- ❑ Size: -Diameter- -------- ----- Depth1s ------------ - -- --------------7--Liquid Capacity_y- -------------------------gals. Privy: Distance from nearest well ..................... -----------------.-----Distance from nearesf building-------....-.-_---._....-----..---------- ❑ Distance to nearest lot line } --------- --- - ----- -- Remodeling and/or repairing (describe]::--- - Yn 4 f ---------- ------ -- I 1' -- - • -- ----- -- --------- --- ---------- ----------------=-- , --------------------------- -------- ------------------------------------------------------------------------------------------ --------------- ------------------ --------- I hereby certify tha ave repared this``application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules nd�reg #ions of the San aquim Local Health District. (Signed) ------ --------. - ------ :. (Owner and/or Contractor) _ ------- {Title) ` By:. :_ = --- -- (Plot plan, she ving-'size of lot, location of system in relation to wells, buildings, etc., can be placed n revers side-- ' + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.-/-. Ala.Y r`_ DATE----- ---------- ' REVIEWEDBY---------------`----------- ----------------------------- -------------------------------------------------------- DATE-------- -------------------------------------------------- - BUILDING PERMIT ISSUED-------- -- ----- ----------------- -------------------------------------------------------------- --- DATE- - - - ------------------------ Alterations and/or recommendations--------------------------- -- -------------- --------------- -- --------- ------ ---------------------------------- --------------•---•---------------- ----•-- ------- ---- --------------------- ----------------------------------------I------ ---- ---------------- ---------------•-----•---•---------•------- -------------------- -------- - ------- ---------- --------------------------- ------------------ -------------------------------- ------------------- -- ----- • ---------- ------ --- ......... - F ......... . ............. ... .......................... ' FINAL INSPECTION BY:--------_ew---✓- �?� Date...._ - �'� e�--....... . SAN JOAQUIN LOCAL HEALTH DISTRICT F 1601 E.Ha:el+on Ave. 300 West Oak Street 124 Sycamore Street 205 West 9t1,Street Stockton,California Lodi, California Manteca,California r 111 Tracy,California � E.H.9 2M 1-67 Vanguard Press I