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' I Y -= - APPLICATION POR SANIT�,3TiON PERMIT Permit No. (Cornplefe in Duplicate)% ------------ ------- ---- -- This Permit Ex ires ] Year From Date Issued Date Issued _ Application is hereby made to the San Joaquin Local H This application is made in compliance ealth District for a permit to construct and install the work herein described. with County Ordinance No. 549. F JOB ADDRESS AND LOCATION ----- - ----- r __ -"----------------------------------" .._�_--"-_••------_-.--"-_-'"---•_ Owner's Name Cl_L--�'----- ho ----- ( -_ P one-,Address ---.-•-- ----;------- # --------- ---------------- _ •---------•------- -------------------- ------------------------•---•---- . ...." -------`-----• Contractor's Name---_-"----- ---- ----- - -- ----- -- ---------- --------------- - ------------------------ Installation will serve: Residence Apartment House Commercial ` ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ . ,..,�,....., ,r Number of bedrooms v2__ Number of baths -_�_- Lot size ---J Q ` X lav--------------------------- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejg' Hardpan ❑ Previous Application Made: (if yes date. --.) No 9 New Construction: Yes ❑ No ®' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if_public sewer is available within 200 feet.) �, at ink: Distance from nearest well-----------------Distance from foundation------------------ - No. of compartments - Size Material ! Liquid depth- -------- ------Capacity------ ---------------- ield: Distance from nearost well_--------.-------Distance from foundation--------------------Distance to nearest lot line-------- ell of lines----------------------------------Length of each line_--------------- ------.Width of trench------ ---------------- Type of filter material Depth of filter material- Total length --------------------------------------- r r Seepage Pit: Distance to nearest well__C1�4Y°-' ---Distanc om foundation__,` �__ .-__.Distanc to nearest lot line-- . ______--Lining material- -- .0-.".� Number of pits...;__.----------- C---[�----Size: Diameter-___,�3- --------Depth-------a`�----------- -- . Cesspool: Distance from nearest well-----------------Distance from foundation__..--_"-- -------Lining material__ ❑ Size: Diameter--- ----- ---Depth----------------------=--- -- ` ------------Liquid Capacity ----------- 't Q :K Privy: Distance from nearest well-----.-------- ...........__--------------Distce from nearest building ❑ Distance to nearest lot line---_".-_--_-__,---__" -------------------------------------------------------------- ---------------- Remodeling and/or repairjng (describe:--_.--____"___________ - ,r ------------------------------------------------------- 1. I -"t_.• ------------------------r----------- -- f----------- ----•—' .. r I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fe laws, and rules and`regulations of the Sr Joaquin Local Health District. (Si ned g ---------- a �. - ---- ---------------------------------------------------------------- -(Owner and/or Contractor) r 04 / By: p '--- --- f ---------------- ----- --- -------(Title) {Plot plan, showing size of lot, location' ofsystem irS relafi to wells, buildings,"etc., can be placed on evrr erre side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ______ s ----------------------------------------------------------- DATE----------------- REVIEWED BY------- - ------�:. ,a. �....,, w �..`w,... /".- ------ = -- - ----------------------------------------------------------------------- DATE----------------- :_-------- BUILDING PERMIT ISSUED------------- - - _ --------------------------- • - D. TF--------------------------------------- Alterations and/or recommendations:---=-_". -- - _-_ _ ------------ --------- -------------------------- v ------------ ---- ------------------------------ --------------------------------- ----------- ---------------------- ........ -- ---------- ----- ----- --------------------- - r- t, -- I! — ------------------------ FINAL INSPECTION BY:----- -__-- -- -__ �� Date ( z - ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street124 S ` ycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,Carifornia Tracy,California F.P.Cq,