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APPLICATtON FOR .SAN#TAT10N PERMI't Permit No.<.. ��._ J.2 (Complete in Qr cote) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work,herein described. This application is made in complia with County Ordinance . 549: r JOB ADDRESS AN ©CATiO Owner's Name.� = ' �.::.�.. . s Phone Address___...'...... _ .._.-- --- --- ----- - •---- •--•-- Contractor's Name . = w Phone.... ::... .. .......... Installation will serve: Residence Ee Apartment HouseCommercial (]i~ Tra' r Court., ❑ 1+ Qr,71-a r � t Number of living units: ____._ Number of bedrooms_ Nuin!�gr of baths ___: Lat size ....l t; ............. Water Supply: Public system ❑ Community'system ❑ Priv"ate jVDepth to Water Table � ft. Character of.sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay.Loam ( Cla�b Adobi� 'Hardpan Previous Application`laiade. Yes ❑ No New Construction: Yes- No [] FHA/VA.Yak Q NQ. TYPE,OF fNSTALLATION AND SPECIFICATIONS: ` (No septic tank or'cesspoO-pormitted-if public pwer is available;within.200 Septic ank: Distance from nearest well ";Dista 9 fr uryationG�"t+ a#it - No. of compartmen#s Size. °`� - Liquid rtlepth : - r -------Capacity f 7 Dispos Field: Distance from nearest wel Q istance from founds#ion_ _: _ istance tp-nearest lot,. Number of lines........:. ___ _ ........... ength of;each line:___-_._,_-- .D ---Width ofirs cll..__. ; _, . t Type of filter materi _/ pthsof filler' material :.... . .......total length _.,_.. .......V............. Seepage Pit,- Distance to nearest-well _-__.______________Distance from foundation_::.__.- ..e... ...Distance t, -. earest lot line.............. Number of pi __ _________________ ining maeral__- _____..:______.. ze: Dimeter._ . .................................❑ Cesspool: Distance from nearest well______________-Distance from foundation._..:_............... rrl±iiteriial, , _..__::_............... Q 'Size: Diameter--___ ..__. ____ -__....Depth............................. ..........Liquid-Cap3itity ....._gals. Privy: Distance from nearest well........ ----- --------- ---:_---------Distance from nearest building.............._. ..... ._;:. .._.. ... Distance to nearest- line -... ......... --•-... . ..,:...................................... RemodqWg, ncl or re. air ( scribal - : .�. ..... __ ______ _______ ._ _.. _ ...... --------------------------------____.........__........ ______----------------------........._......... I hereby e'that I have prepared this application and 46t the work will be done in accordance-wfth San Joaquin County ordinances. State laws, and rules and regulafions.of the r-San Joaquin Local Health District. (Signed),.. t`s"`> ... • (Owner and/or Contract or) Sy:----- •----•. -_..._. ..._.... .............................. ....... ....... _...-•--(rfleJ=- -..... -----..:_ . (Plot--plan.shoawing,size-of lot, location of system in relation to walk, buildings, ate., Maar be_aplaced onf~* FOR 1PAttTIuIENT USE QNLY APPLICATION ACCEPTED BY. . DATE:: .. _�:: REVIEWED BY.......... - -- -.__ .._ DATE BUiLDING PERMIT ISSUED ........................... -•---................... _..._... DATE_ .............................................. AlteraVons q d/q re c Van -. 4 r c. -- Z3--:757----- - - ........ .RKY FiNAL iN-SP --04Date_...... . �3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh Ametiaan SfreO 300 W"t 0e1 streof 132 Sycamore Sfreet 014 North."C street Stockton, California Lodi, California Manteca. Gal'ifornie- rtnay. Califoruta ES-9-2M Revised 1-57 F.P.CO.