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FOR OFFICE USE.. ---- ------------ - - ATION FOR S ITATION PERMIT Permit No. -_.-�-�•--J---•-� APPLIC -------------------- j p illicate 1 Ye } Dais Issued . ► ------ (Complete In 4 I k From Date Issued ------------- - k Thtgs Permit Ex Ices "I{ Application is hereby made to the San Joaquin Local Health Distri ft' or a permit to.construct and install the work herein described. This application is made in compBance with County Ordinance Na. '49. " ty } t s JOB ADDRESS`AND iLOCATION--------. �'� • ' '/ _ Phone..---------------------------------- Owner's Name------------ e�/......... • Address--------- ----t- , - -------•------ -------- •.... Phone ---•-•--- •--•-•--••----- Contractor's Name ' ' Installation will serve: Residence A Apartment House ❑ Co i'il rcial ❑ Trailer Court ❑ Motel ❑ Other ❑/ �xT �` ..._..... Number of living units: __�._-• Nurn er of bedrooms ___ L �. N ,ber of baths ._,r-L.Ot sae ___._. ._-- - I Water Supply: Public system ❑ Community system ❑ Peva l Depth to Water Tea ,yf Hardpan Character of soil to a depth;o# 3 feet: Sand ❑ -Gravel ❑ Sa- Loam❑ Clay Loam Cla Adobe❑ ❑ M FHA/VA: Yes. No ❑ Previous Application Made: (If yes,date_--_'._-------------1 .No }, Ell Construction: Yes No ,C] `� TYPE OF INSTALLATION AND SPECIFICATIONS- (No if` ublic sewer is av i able within 200 feet.) " (Na septic.tank or cesspool p �n7•,I�� I Septic Tank: Distance from nearestlweA:_ _�-Distance;I-om ''^oYm oundation_.._,P ./_.Material__.. _' - -•--•-••- -- ,F No. of temper+meets Size ' Liquid d�th ..._.Capacity.... . Disposal Field: Distance from nearest well_ _r___Distance foundation..__Zn_:"�'__Distance to nearest lot line.... I 0 '"_� Width of trench._. ------ ... ...........� ' [ Number of lines----____--�-- -------------------Length each line_..__-- t ,, �s—A Type of filter material._.;. " =-'`Depth o Ifilter material--------/+�-----..._.Total length........ ._ ?-._----••----..._ 4 f t p g r� m foundation..............__Distance to nearest lot line-- Seepage ine__ . \ -• _material -Size: Diameter-----..----- Depth----------------•- EI Number of its__ _ _ _ ___.______.Linin matenal___. See a e Pit: Distance to nearest we °______._-_ Cesspool: Distance from"nearest_wel!___..._._-. -Distanc a��m foundation__-_.____-___-___.Lining material______________--;_-_____-----Size: Diameter----------------- - p -----------....--------------------------..Liquid Capacity.._-----------------.. g g•--------------_--------------•----- Privy: ---- �1 Det •--�;i � Distance from nearest building. _ Distance from nearest well_____ ______ _________ _ ❑ Distance to-nearest lot line----------------------------- _ -------------- ---- �''•r Remodeling and/or repairing (describe):-------------------------------------- - -------------------------------------------.---------------------------------- ._............. . -• - , .....-----•----... -•-•-...-•------------------------ ----- -- •------------- ---------------------------- ----------------------- --- --- - i I hereby certify that I have prepared this application and f the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Jo16in Local Health District. > -ov - - --------------=------------- •I (Owner and/or Contractor) (Signed}.------ - ---------- -- ,... < < .----.- . .............(riiifle)----------....------- ------------- (Plot plan, showing size of lot, location of system in relation to 11s, buildings, etc., can be placed on reverse side). -FOR PEPART I NT USE ONLY I APPLICATION ACCEPTED BY "-----•----------------- ------------ DATE------- a---------------------- REVIEWEDBY_------_----------------------------------- ---------•--------------- i------- -- ------- DATE........................... i ------------------------•----•-- D Er ..-.-•---------------------------•-------BUILDING PERMIT ISSUED Alteratto and/or�recmkmendaflons-__-___-- 4-,--� --- ----••- ---- �C /' a,..�-----11-e .-------- M = = 't` �.� - ~ mac•-��Gk �-�� .�-?�-_ �-•'`��-----�,��=� F=�`-s�=�_... �.-� •••t's' -------g tY ------ ---------- --- C f-_' �y moi: z �2C�- ' rt - � > .. •' � --_-- ------ �5_Yi> C7 ? L �Q r act, �( .rc j .—rte `I► < < J �.G -: Date_ -_ �`"`y cam. .,�G�+,�. �s• .�-ti—y,-tom(-Fri-`--Cv-e.� _. FINAL INSPECTION BY:.._.-- -- M _i-_fJ _ .-------- -'�� -`• ,�� c..f�-,.l ,�J�..�--ems �'-� ,�-�;•.,-�>�,-{:`��t=-,z/`� � .• SAN JOAQUIN LO �L HEALTH�DLY 130 South American Stre 30M.1 Oak rylfyyP 124 Sycamore Stroof Z05 Wecf 9fh Stro�l Stockton,California California J /� „ }y�Manteca,California Tracy,California f-f7 ,�lh/�'�'�`�✓''•-.--a.� r.. �, �:g ��c�. fir/ ES 9 REVISED 8-89 2M 5-6r ATLAB -,�s.�.�•� eri G��=2� - .w