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FOR OFFICE USE: (o 6— ��°�� 5 Permit Na. ._._ �� APPLICATION R S NITATION PERMIT �- , �- ---- f l (Complete in Duplicate) Date Issued ... ........f----- . This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in coinpliance,with County Ordinance No. 549. 3 030--0 w 1 Lo`hJ[J19rC1 #' JOB ADDRESS AND LOCATION q-�-��-�-------��-G`C�EY-----•=`�_[�j G_IC----�C?-ham_ --�---�-`-t-3'--t_IC�.-isa��- .---------•---------------------- Owner's Name---- L'--'----_-1�_ ��A'v. ......h4_' - AAE Address-----...... "- _A------- -91--c-------• `:Z:,--- �1 Contractor's Name------a.Lu- -------------•---------•---------------------------------- ------------- --------------------------------- Phone------------•-------�a b�- Installation will serve: 'Residence ❑ iApartm Apartment us ❑ Commercial+ y T -1 r Court ❑ Motel ❑ Other ]) C..6►'n Z �00---�C.3tE ------------------------- Number o_f living units: -------- Number of� ------ Number of s --_ Lot size _-- Water Supply: Public system ❑ Community system .❑ Private Depth to Water Table 4 ft- Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [, New Construction: Yes No ❑ FHA/VA. Yes El Na ®. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 0------Distance from foundation-__A L---------.Ma�erial__ - -D ------------------ 1 i F f Z.C�FD 0 s No. of compartments_-'Z�-----------------Size-,S__ fel_ -�---- ---Liquid depth---5!-�-----------Capacity 1 (Disposal Field: Distance from nearest well_ Q--.__..-.Distance from foundation----�_Q_-------_Distance to nearest lot li{i-- -..-.__-. (I Number of lines-- ------ ------------- -- Length of.each.line-------�-Q ---oy------.Width of trench---.- - -------------------- / Type "of filter materials ir-C1ic_L__-Depth of filter material---_._�_- -.--i_ -Total length---_ ---------------_----..- „ y 1 l Seepage Pit: Distance to nearest well-_-3.0-0--------Distanc0fr,om foundation-----a_0---------Vistance to nearest lot line---6 ]r,,,�� _ _ ,,_Number.of pits.': -_-----. --Lining material - .iCDG _.Size: Diameter-x---K-10. - -Depth----l-Q-f---------------------•� s.K . Cesspool;.„•Distance from nearest well-----------------Distance from foundation--------------------Lining material----_----.--__-.-------------------- Size: Diameter------=-------------------------------Depth-----------------;----------------------------------Liquid Capacity_.------ gals. ❑ _ . Privy- Distancerfrom:nearest well--------------------------------------- Distance from nearest building--------------------_-_---.-------------- y --=------ ❑ ----------- -------------------------------- -------- Distance)to nearest lot line--------------------------- - 1 • lE; s ] _ ' Remodeling.�anel/or repairing (de'crlbe)------------------- - - -- --------------- - III _ . . r ----------- ---------------------- ----- ------ -.= '. = r t -r" A ` ------------=---------•----•--------------------------------------------- 1--heir-e-6-y--certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County r (ordinances, State laws, and rules and regulations of the San Joaquin.Local Health District. Ar f .(Owner and/or Contractor) •(Signed] ' ` ------------------- ----- --------------------- ---------------- . _ - - -� (Title)------ -------------------------- --------------- ---------9� BY= - ------------------------------------------- _ - •(Plot plan, showing size of,lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). .IN , {� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------0----' `''" 5------------------- ---------------------------- --•--- DATE--- = i0 5-------------------- :REVIEWED BY------------------------------ ---------------------------------------------------------- DATE.---- -----------------•---------------------------- -- DATE BUILDINGPERMIT ISSUED------------=-:-------------------------------------------------------------------------------------- , ---- ----------------- ------- ' � ------- - `Alterations and/or recommendation -------rrme_ 1 € ° -- j - ---- ------- -------------------- --r----- �---------------; r----- --------- ra --- ivl �w� �G�-tn �' - . ,00«C - a-- ------------------------------------ ---------------------------------- a 1 t ------------------------- ------ ------ FINAL INSPECTION BY.---- ----- -1-------, y. -- - - .... [ i --- r,.... � SAN JOAQUIN LOCAL HEALTH DISTRICT 16o1 E.Haxeltan Ave. L 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r y;;,,,,,,b„•.�,�5_9R�VISEP s-59-3M 3-'63 F.P.CC.