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''.FOR OFFICE USE: r' ` 1 ` ------------------------- APPLICATION,,FOR-,SANo.NITATION PERMIT Permit .....:........ . ----------- -- ----------------------------------- . `------- ------- ------------------------- r----- -K'-- (Complete in Duplicate) t. Date issued ---.... -. =This Permit Expires 1-,Y,ear From Date.Issued_ _ Application is hereby made to the San Joaquin Local Health District far a permit to construct and install the work herein described. This application is made in compliance with,County Ordinance No. 549. JOB ADDRESS AND O ATION_ i � ,�-z u b ------------------ -------------"-------------------------------—--- - .. --°------ -------- � �' a n� IV 4 1Y1 f3�R Owner's Name-- Phone ,?-7-3 y ' Address / ' C/� / '.E.r1 -277 ---------- ,,qq I ; Contractor's Name----------- e =# -----••------------------------------------ ---------------------------------------- ---------•----- Phone..----•----------••-----------•---- f F Installation will serve: ResidenceApartment House ❑ Commercial E] Trailer Court E] Motel E] Other E] Number of living units: ........ Number of bedrooms _ .. Number of baths -------- Lot size -../............................................_.-_------._ Water Supply: Public _system ElCormmEl 1.0— unity system Private Depth to Water Table ff. Character of soil to a depth of3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑� Previous Application Madel(If yes,date..............._.._) No ❑ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE= OF INSTALLATION AND SPECIFICATIONS: 0 k•'�(No septic tank or esspool'perm�s/itted if public sewer is available within 200 feet.) � i % 4' i ! ; - Tank: Distance from nearest well__d�d........Distance from foundation. .�.0__-.-----Material_.1V�`--------------------------------------- SepticC t. t 15-- No. of compartments`a-------------------Size._-G--X--V1_-.!r-1I?quid depth----Lj--.-(a------ ---Capacity-J-2--SJ-p---- Disposal Field: Distance from neare t well___.:.......Distance from foundation..... ...._....Distance to nearest lot line".5.......-.- i � + Number'of lines' ----------------- ! � f� h lined /r!c Width ofrench----2---------------------- ' ,Type offilter m; aterial � iter material-.1-9-. --------- endth... .. ...T ..----.0-_--._------------------- Seepa.ge Pit: Distance to nearest weft.....................Distance from foundation-------------------Distance to nearest lot line---_----- _ ❑ Numbers of pits-#-------------------Lining material----------.-----------Size: Diameter-----------------------Depth--------------------------------- it Cesspool: Distance from nearest well-------"------ --Distance from foundation....................Lining material--------------.__-----------_----- ❑ Size: Diameter.-I--------------------------------Depth--------- -------------------------------------- ---Liquid Capacity----------------------------gals. 1 Privy-.1. Distance from nearest well-------------------------------------------------Distance from nearest building............------------.-_-.-_---------. Distanceto nearest lot line --------------------------------- -----------=------•------------------------------ ----- ---- ------------------------ r ro Remodeling and/or repairing (describe):---I&I-------------------- - ------------- t ry / y ©-C�r /r a�vf3 ADO/ l'---;r t�/3 -ef.. _ __ 1 -- Fhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Di ict. {Signed)-------------------------------------------------- ----------------- --------(Ownerand/or Contractor) - - Plot tan, showing of lot, location of system to relaf--n-to- "--"_ --- -------"----"--------------"-Title .. Y [ J---------- ---------------------------- --- --------- ----.. p g t y wells, buildings, etc., can be placed on reverse side). Q DE ARTMENT USE ONLY APPLICATION ACCEPTED BY- ------- • ---------------- -------------------------- DATE------ �5�= �' °--------------------------- IREVIEWED 13Y.- - ------------------------------ ----- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED------------------- --- - - --- ------------------------------------------------------------- DATE------------------------------ -------------- I Alteratiollns and/o recommendatir -- �j : 1 s - - ---------�-�-----------------••-- iiifff"`/// - 7)c 1V ----------------------------------- ---- ------------- ------------------------ r �.y FINAL INSPECTION BY:-------- - -- a----- -------- Date -/. r�-,/... >� 7 SA J IN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street h ' Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 a. `,,