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' FO R 0 FF I CE USE: ~�r | ---'If �PPLICATION FOR SANITATION PERMIT Permit No ' _-��-- ~°" ~ 6» Duplicate) Bate Issued This Permit Expires 1 Year From Date Issued /--- Application is hereby made to the San Joaquin Local HouKhDist rictfor apermit toconsfmctand install the work herein described. � This application is made in compliance with County Ordinance No. 549. Address--- .....4--r-�- � | Phpnm-��u4-�� . Contractor's Nomm._. --' ------------'--------' ' i Installation will serve: Residence � Apartment House [� �om . °�° Trailer Court [] Motel [] Other [] ~ _ ~� . Number living units ---' Number ofbedrooms ---' Number of baths --.. Lot size �J��'��'��!-��.��!-A---- Water Supply: Public qe+mm''�z�' Commu*NY system 0 Private E] Depth foWater Table -------- ft. C | hmrmmtwrwf sail to m depth of 3 feet: Sand [] Gravel [] Sandy Loam [] Clay Loam [] Clay [] Adobe Hardpan [] ' Previous ApplicationMade: (if yes,6o+n--------------------) No$ New Construction- Yesg No [] FHA/VA, Yes [] N^;K TYPE OF INSTALLATION AND SPEC|F16/TIONS: (No xmptimtank or cesspool permitted if public sewer is ai|ab|wwithin 2009eet.) i � SeptiTank: Distance from nearest n Distance from ,o D� *�ron *� mon*. Disposal Go|6: Distance from nearest *nn.la�wm �cu/muncmfrom founuu,/on_/V~-------------Distance ." nearest ."` "�e.-�.-- .......... ------------- Number of linof each no '�� -'� _- v�+h of trench - - � _-_--.-'-.-...��Typo of filter m*+er| .. � - � Seepage Pit: Distance to nearest weU.--_---..Di�unco from founJo�on-.-..'--_-Dbtunceto naun� lot n ' [] Number of pits---------------------- mu+eriaL_----.-Size: Diameter------------------------Depth------------------------------- Cesspool: Distance from nearest ~oK-'-_-''D��nc* from foundo�on--_-__Un�g material----------------El Size' Diameter-------------------------------------- ----------------------------------------------------Liquid ----------------------------gals. Privy- Distance from nearest well ---------_.----Dis+ nco from nearest building-----_.—.----.—.- -v / [] Distance to nearest lot line'—''--.'''-'''-''---'''------------------------------------------------------------------------- __--_ d/o repairing (Jnocr|be):--.^�W�°^�- -_��'—mm��^��^�"�^'��,�nr=� - . �__..--.-----.'-_--_---_._-___--_--_--___._---------_-__x�..—___ ' ----.-------------_-------.-----.....'------------..'....--.----__---.---.---.--..-____-'-_-_--. -----------------------------------------------------'----------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. ' (Signed) --' . - -----.-_-------.---_------..{Owner and/or Con�wu+or [ -------'---'---''—'—'—r' -'—'---------- ---- �� plan, showing size of lot, location of system in relation to wells, buildings, �� can be placed on reverse side). FOR DEPARTMENT USE ONLY � DATE ��~�� ~� /\PPLP/g[|(�N ACCEPTED _��__ �_._-.- REVIEWEDBY-------------------- ------------_--..,-_---___-___--..---_-_' DATE...................---_._----___—. 8U|LD|NG PERMIT IS6UED.'-�- -----------------------------------------------__-------------------------------------- u,,.u-----__-----______ ' --- tZ--fd5- ----------------------.............. -------- .—''-'—'--'-'-- -- ------------------ ----------------------------------- ' r FINAL INSPECTION B Date------------------ ---_—.- JOAQ0NLOCALHEALTMDISTRICT 130 South American Street 300 WeSt Oak Street 124 Sycamore Street 205 wait 9th Street Stockton,California Locl/.Canm�/a Manteca,California Tracy,California ' "" p "Ew"o, °'", ,u o'°/ mu" _