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~ APPLICATION FORSANITATION PERMIT Permit No. <br /> ~0 .(Complete in Duplicate) Date Issued -.2-znY <br /> Application is hereby made to the San / <br /> Joaquin Local Health District for a permitfu construct and install the work herein described. <br /> This . <br /> application is made in complianceCounty' OrdiNo. 549 <br /> nance <br /> �&j--------- <br /> Owner's Name----------------�R.&Xj- ----------P1 NIAVY -11 <br /> Contractor's Name <br /> ^ - - - ' ' _----''-' Phone''''--''''_--'- <br /> |nstallation will serve: Residence nnf House [] Commercial [-] Trailer Court 11 | 1:1 Other El <br /> Number of living its1 Number of bedrooms3Number of baths /- Lot size ----- --_-----.--- <br /> Wafer Supply: Public system � CoPrivate O Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of o6v Loo y Loam E] {Joy E] A6n6o [] Hardpan [] <br /> ' Previous Application Made: Yes Ej NoConstruction: Yes E] FHA/VA. Yes F No E] <br /> TYPE OF INSTALLATION AND SPEC|F|CAT|{}NS, <br /> [Nb septic tank mr'cesspuo| permitted if public sewer is availablewithin 200 feet.) � <br /> from founcla`t;o`n�J2077777� <br /> 2- <br /> Disposal F|o|6: Distance from nearest we|L.5-6/--.. ' <br /> Number of |ino`_� "�`.. ` --'-�--'' <br /> f�ar moh,�oL' '-D�o+ of mmt���-/� °.'--Tota ' <br /> Type of <br /> Soepmgv Pit: Distance to nearest weL.---.-_.Dist*nce'from foundation-------------------Distance to nearest lot line---..^�-�~ <br /> E] Number o[ pits----------------------L�ning material----------------------- Diameter-----------------------Depth--------------------------------- <br /> Cesspool: <br /> '--''---'-'''Cosspoo|: Distance from nearest well-----------------Distance from foundation------------------- Lining mofe6aL----._-'_'_- <br /> [� Size: Diameter--------------------------------------Dept ''''�'�----''''--'''---Liouid Capacity----------------------------ou6 <br /> privy: , Distance from�nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> Distance to <br /> -__-..__-_''-Distuncufo nearest lot line-''--''��--_.'''''----__'-_.'---_.�---.--_.'-_.''---'-''''�--'- ` <br /> Rvmvdoing und' or repairing (describe):__'___'-''^____-_-'______________________.____.___.______________. <br /> --------'-------------'---------------`---------'-------'-----`-------'------------'' <br /> --------`--------- -------`------------`-----``--------------``---------``--------`------'`---------'`--------------- -------``--------`-----```---------------'-----`-------```---------``--- <br /> _-_-__-__---_--__--_--------_--_------------_----_----.-_---------.--------------- <br /> | hereby have p repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> `-~--''',r' ' ----------------------------------- (Owner mnnyn, `.nnnu*roq � <br /> By:----------------------------------'-------------------------------- ----.-__---------.]Title) ----.-___.______-----____.. <br /> (Plot plan, size of lot, location of sysfem in xe mtion +n,/eUs'.6u i|6inmv. e+w. can be p|mmwd onreverse si6e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y.-.. -.. -_._-_--_- DATE--- �������, <br /> �' <br /> � r_~ . ' <br /> REVIEWED BY'.^_..---__�'-__._'_.______________._______ -------------- -^_�-_ <br />� <br /> --BUILDING PERMIT |55UED__.- ------------------------------------------------- <br /> --------------------------------------- DATE----- <br /> Alterations <br /> ATE_-AHo,oGvno and/or recommendations:----------------:------------------ <br /> ---------- --------------------------------------------------------------------------------------------------------------- <br /> ----------------------'__-'-_.'__-''''-_-''''_-'''''''''---'''-__----'''_-''---''_--''---''--_---'___-_-_-'- <br /> .------_'-__-._.__--------._------_------__._---_-_-__---_.__-----_'_____---.. . <br /> _-_-_--_-_-''---'-_-'---_--'--''-'''-'-'---'�'-_-''--'''-'-''---''�_-'''--'---'''--'''-'-'- ------ <br /> ----- <br /> '-''' <br /> --'_--_-_--------------------.----_'_--_-_--.---.. _----.--.--.-----. ` <br /> FINAL-|N5PBCT[)N BY:--''' -'''---''-- Date---------- <br /> SAN <br /> ''-SAN JOAQ0N LOCAL HEALTH DISTRICT <br /> mo South American Street 30D West Oak Street /az Sycamore Street 814 w"*h ~r' Street <br /> e""e"". California Luai. o°m",Aiii Manteca, California nnm^ California <br /> ES-9-2M ' Revise" 1.57 p pco -- ' <br />