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FOR - ICE USE: / �0' 13 <br /> z�� APPLICATION FORSANIT ION PERMIT Permit No. <br /> (Complete � <br /> --'''--'-' Date Issued <br /> Application is h*m6v m*6a to the San Joaquin Local Hom|fh District for a permit to construct and install the work herein described. <br /> This application iomade in compliance with County Ordinance No. 549. <br /> - / <br /> JOB ADDRESS '<��_ <br /> _-.----_ -------------------------------------------- Phone_-___.--_------' <br /> Addmws...-----------:��--.��a_~C_9�-^�����-��- --.-------_.----------'----_---'----------' <br /> Contractor's Name---------------------- .....--------------------------------------------------------- ........................... Phone.................................. <br /> Installation will serve; Residence rtment House E] Commercial E] Trailer Court [] Motel 0 Other O ` <br /> Number ofliving units. ...../ ��nf �o�,uom,^ .. Number of baths _4, Lot size f� ' <br /> Wafer Supply: Public system [T�ommunity system 0 Private [] Depth TO VYuta, To6|a �z��. � <br /> ^ ~. <br /> Character of soil to w depth of 3 feet; 6un6 [] G>mvo| [] Sandy Loam E] Clay Loom [] C|ay,,E] Adobe El,~11m,dpan [] / <br /> Previous Application Made: (If yes'6owo--------------------) No Er- -Now Construction: Yeo 0' No ' FHA/VA. Yms [] NwQ~'~ � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted R public sewer Ys"mrmUm6|e within 200 feet.) <br /> ' <br /> Septic k Distance from nearest well------Diotanco fno,m foundation . <br /> ' -Mufo,iu| -'-'''------- <br /> q , No. of d ~»` <br /> / ^��. ~\ ` <br /> . <br /> '' filter m--i-- '---'�� - filter- ----'--~--T-'-- len—"'----'�-----------' \ ! <br /> �� R+' D�m�o � m��� .�| /���. � m�r�+ |o+ |7�� � <br /> �^�^<� .. .. ~~...~ `-'= , ___ � <br /> °^�« Number ~� Uning �/��u 3�'��� ����' �� - ' <br /> ~~—v --''v"\-- �--'�-=^—� ' ---~ --' . -------- --------------_- <br /> V 'o,� <br /> Cesspool: Distance from nearestwoL.-_.--D�tunonfnzmfovn6u+�n--''-_'-Un�gmo+oMuL--'_-'-'''-''- ' �\' <br /> ' / <br /> [] Size: Diameter�- -'-''---'--Doof��'-� -----------------------------------------Liquid Capacity.. _-'-'-''-'.gals. <br /> Privy: "Distance from ��res+ well --- ----------------------------------------Distance from nearest building----------------___.._-�- � <br /> [] Distance tonearest lot line-.-'--''--''--.---.-__.'__-_--__.--___.___--_--_--- <br /> Remodeli 0%, / <br /> ' - ' <br /> �- ..... . ... <br /> ------����--�---'�--- --'~=~-------'''---'------'-------------~----'—'' < <br /> - ---------- <br /> --- <br /> ---------- <br /> _-_ ------------------------------------------------------------------------------------------------------------------------------------------------------------- .-----. <br /> | hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Srwrw laww and rules District. <br /> &� <br /> ''��/ ----------------- (Owner m Contractor) ' <br /> `-- ------------------------------------------------------------------------------------------_-'-_-._' ........... --------------------------------------------- ------ <br /> (Plot plan, showing size � lot, location of system in relation to wells, buildings, ^� can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ' - ' ----- <br /> ~~^~.,. � <br /> Alt N sl <br /> | <br /> ._ <br /> zm - <br /> ----'''- ��--'--''�]�'----� -- <br /> -' 'x ��-_.x�c----------�---_----._. ___.__________---____.______ � <br /> \7 o <br /> FIN/\L INSPECTION BY ...........6�f��--------------. Date..... / ------.-.. � <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> � <br /> 130 South American Street n0oWoof Oak Street 1u*Sycamore Street 20mWest p1hStreet <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES p ncwocn 8'59.2m ,'xz ^rLxy <br /> _ � <br />