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_. '`--....... ...��"'-�.. APPLICATION FOR ON PERMIT Permit Na. R SANlTAT! Y. ..............._ ...... _..-.V...:....' ..�`. .. .bl.. lCornplate in Duplicate] . » This P ormit Expires I Yttar I"rom Da#+a Issues! Date Issued plica#teui is:hareby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. nis application is made in compliance with County Ordinance No. S49• ;i JOB ADDRESS AND LOCATI N.... jpp Owner's Name. ......_ .._...._...... ----------- Address -------•-Addross.............•---...........y...-•...... , ».. »... Pht ...»._..««....... .. ,. . ' Contractor's blame..... '� =• � * * »»...» _......» ....._..... » ............ ......».._. _... rr,,, .»..,.__..._..._-..»...._».......... Installation will ..........:......».....»»......... Phone._..__............ ' sella: as; Apartment House [� Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ »...... Number of livi»g units. j... Number of bedrooms . -- Number of baths Z_ Lot site Water Supply: Public system ❑ Community system p Private Depth to Water Table Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sand Loom Clay Loam C{a �' •T Y ❑ Y ❑ .i y ❑ Adobe gr-H-ardpan Previous Application Made: {if yes,date....................) No �New Construction: Yes ❑ Ni'.2j-'FHA/VA: Yes ❑ No�- TYPE OF INSTALLATION AND SPECIFICATIONS- // (No septic tank or cesspool permitted if public sewer is available within 20'0 feet.) S,:pt c Tgnk: r .Distance from nearest well.................Distance from foundation..,-----.._ l No. of compartments......._.................Size.............:..............:...Liquid depth...................._.....Capacity__ i Disposal l;old: Distance from nearest Distance from foundation__../A-........_.D;stance to nearest lot �1�L�9IY , Number of lines_...._.. ....�,...-.. ..._..Length of each line..._1?-0�.---_.........Width of trench.. i j, .�.......................: ire of filter material_ , W! Depth of filter material lanc}#la_�yPl'��...-_.,._.. Seepage Pit: }Distance to nearest well. -A9&'0/.._Distance #i foundation_-...,, r l !Number of its...,.,/.............Lining mat&rial.. . + / t�' •- .�Di,ance to nearest Sot line.__ ..._..`_..... '�l s Size: Dinmetetl„ ..��........ ......Dept}t..r.�, `!..»......... Cesspool: --- P Distance from nearest we'll..............._Distance from foundation. ......... . -. .........Linin material...»»....... _ ❑ S;ze: Diameter,. ..__....» liquid ..»»_..._..__.....Depth.....»...r_...»..........._... �+ l Distance from nearest well..... ...... r ._..Distance from nearest buildin ❑ i Did tense to nearest let line.,...............•-- ............................. Remodeling andJor'epairing (describe):................ - t. (rJ! .... » ._....»...._..._..»_......._ .«.................. . .._ y - l ...............«.....»...._.._........__.,...- --.......a»...._...._....:_._.-..._._.._............_..._....:...:..,._....r.,...._......._.......___...._......-.-_.-.--------..-.-_---...-.--........... .-_....__..---- I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State.laws, and rules and regulations-of the San Joaquin Local Health District, (Signed).....-..-........-. ._.".l. :...._.......... ] lel _................ By:................: ...............................•.,._..:. _..._t.�....__.....».• .... ntra .- cfiarj , (Plot plan. showing'sife of lot, loeafi'ron df s min relation to walks, bui#din ` r _.._........ x gs, etc, can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE6 BYf„ DATE....._.:3 REVIEWED BY........._. /-:'.'...,..'.» ..... ..----•--• ................ DATE ��.Z..- .._... ..:....» DATE................... .... BUILDING PERMIT ISSUED.,........'. _............. ......_....._....__............... ,..,.... ...._...................,........ .. Alterations and reco�m�endeti6ns...._..-. ._.__....».__ . v» ... ................. ......... DATE .._........ .. .......»..»..»... .»..».»...._..._ .....» ......._ . -..' ....,., -.:..:. ........ ................._._.. .. ,........_.,.......... ... FINAL INSPECTION ' Date...... .....1� 3316 SAN JOA9UIN LOCAL HEALTH DISTRICT 130$"tit Arnwicnn Strow ` 300 Woo mark srroat f �)7y 5ycamor�5traat Stockton,California ' / 205!Nast Vrh strut ``lodi>California' montoear,California ca 9 MYVrBlD A-59 rM 5-6t ATIAfl Tracy,California 3