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FOR OFFICE USE: -- -- Permit No. . -� .. - -- ---------------- --- -------------- --- - ----- - APPLICATION;FOR SANITATION PERMIT ..-------- ------- -----; (Complete m Duplicate) Date Issued _ 1-. � "---------------------- This Permit Expires 1 Year From Date Issued Application he made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. This application is made in compliance with County Ordinance No. 549. l JOB ADDRESS AND LOCATION------- (��UWAIit.____IL.t,r_"�'-------13-0--------------------------------------------------------------------------------------------'------- Owner's Name-----------------Ono 1r �.JX2®�-------- l ----- � --------- ------ ---- U ,y` __ d_____. c "_________________Address-----------------------------� ----�-------- ---- �� C�`j-N�/� _( . Contractor's Name--------------- - ----------------------------------------------------------- --•--- Phone..------1•------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L,P�E a j Number of living units: -------- Number of bedrooms __----- Number of baths -------- Lot size ----------------------- ------------ r Water Supply:: Publicsystem ❑ Community system I] Private [Depth to Water Table _2--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date__- ------;-------I No ❑' New Construction: Yes ❑ No [/J' FHA/VA: Yes ❑ No ©— _T TYPE OF INSTALLATION AND SPECIFICATIONS: -(No septic fink-6r cesspool permitted if public sewer`is available within 200 feet.) Septic Tank: Distance from nearest well_4QQ._-------Distance from foundation-JA------------Materiaf_7_vu_a5 -------------------------- No. ---------------------No. of compartments-----------P-----------Size--- -x_ 9` --------Liquid dep-th - --. ----Capacity----(_20:P------ Disposal Field: Distance from nearest well_ ° (..._Distance from foundation-_Q, ----.-.._.Distance to nearest lot line____-.-__-____ [� Number of lines aZLength of each line h; -/d- ---------- ------------------ -- r ` T e of filter material_eQ;,�,,,,, �.__ .-Depth of filter material_._'y________________ o�a ----- r� �ft Yp � '=-- ---C=-- --De - Seepage Pit: Dito stance well------- Dce from foundation nDistance tonearest lot line_ _ _ ________ ❑ Number of p - _Lining material Size: _ "_ Depth _ __ __ Cesspool: Distance from nearest well_--_-____--_.--Distance from _ -------------- foundation...._--ti---_.-.__-_.Ciingmaterial _ ----_______._______-_ Size: Diameter--- -------- --- ----Depth - ------- -------- �-- -Lguld CapacitY----_------ -----_----�als,,a Privy: Distance from nearest well-------------------_.---------- ----------- ----Distance from nearest bullding.------__.._---.________----------------. ❑ Distance to nearest lot line----------------- ------------- ------------------------------------------------------- 1 Remodeling and/or repairing {describe:_ 711 --- - 5•� Ons � - �" -----------------------------------------•- ------------------------------------------------------------------------------------------------------------------------------------------------ - -------------- 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 rules and regulations of the San Joaquin Local Health District. (Owner and/or. Contractor] (Signed): - ------------------------------------ - �- - __ (Title)- ---------------------------------- - ------ --------- (Plot plan, showing size of lot, IcAtion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE LY ACCEPTED- ------ --------------- ------- ---------------- --------------------------------- " DATE= .�_=`---- 7------------------------- APPLICATION � REVIEWEDBY------------------- ----- ------------------------ ---------------- DATE------------------------------------------ ----------------- BUILDING PERMIT ISSU D ___ I --------------- -- --------- DATE---------------- - ,----------------------- --------- Alterations and/or recommendations:------ --- ------ ---------------------------------------• ------ ------ -------------- ---------- --------------------------------------------------------------------- ---- ------ i --------------------------- - --------- - --- ------------- ---------Z� ---- ----------- Date------- ---- '�r l-C% l- ------- ---------------------------- FINAL INSPECTION B -- ----- -- -- -- -- -- ------- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street J Stockton,California Lodi,California Manteca,California Tracy, California ! µT• J F,P.CO. \ f