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FOR OFFICE USE: ------e------------------ 7'3.0.------ _.....__-__--------------------------- ____----------. APPLICATION "FOR UNITATION PERMIT Permit No. ---------------------------- -- -- --- ---------------- (Complete in Duplicate) J / Date Issued --------_---_---------------------------------------- _.. This Permit Expires 7 Year From Date Issued --7�a ✓b 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION �� 1 ! j 5�40_r)---------------------------------------------------------- Owner's Name----------5-0b-----Clar_�------------------------------------------------ - ------------------------------ Address---------------------- ----------------------------Address---------------------- r - lrl7_lsa`k_ _-_ ?'3 Contractor's Name--------- . 1 _'.__ sal_r:_1-:1_ -- 2�-SJ----Lac k------------------------------- Phone___-1-�.4,-9/a.Q7- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms __z..- Number of baths --- _--- Lot size ---- —4'Y- ._ __ .''� Water Supply: Public system Community system ❑ Private ❑ Depth to Wati r!7ab_e -------- ft. Character of soil to a depth of 3 feet:TSand-❑'—Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ ' Previous Application Made: (If yes,date--------------------) No ❑ New Construcfion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: b (No septic tank.or cdsspool'0iirihiff6d if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Materiai------------------------------------- -_---. ❑ C�6J % No. of compartments----'---------------------Size--------------------------- Liquid depth------------ - - ---------Capacity----------------------- Disposal Field: Distance from nearest well------ Distance from foundation.... ------Distance to nearest lot line___ -- /------�-:----L'e'ngth of eac:1 line-----:-----9Q--------.Width of trench-..__�_ / ) EX� i-. Number of lines i - i� , J� Type of filter material_;'_ `L__Depth of fiiter�material�',. �/_--_.__._Total length____.______ �?_ ______________-. Seepage Pit: Dis#ante to nearest well=_:. _ _:,-_ .-__Distance fr fo dation___--' --_--.Distance to.nearest lot line--A0 rV! y Number-of pits--- -- ----- -----sLining material_:_ _Size: Diameter------- ' . .FDepth= /------------- In Cesspool: Distance frornfnearest well _#_..-_ -Distance from foundation__._-------- Lining material-_�-------------------------------- ,,, ,- ❑ Size: Diameter: - -- - -'f�---------Depth------ ------ ' `�}� �' `"#' ,::Liqu'isd'C pacitY ------------------------gals. Privy: , Distance�fom nearest well-_-._--:---- ---------- ;- --=-`-M---------Disfance from nearest building-------------- -'-------------------- Distance --- fo nearest lot line------------------------ Remodel'ng and/or repairing (descri e�_______________ � rxz� _ -___!/r��/�sa _ I/� �.. _____ --------- �c2C (�1''d1 --- � `�Y�, � � ��'��'X17 ---------------------------------- --------- - --------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------- I hereby 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 District. (Signed)---------�,�/' _ /�J/✓- fy ,/e. _< r-----------------------------------------------------------(Owner and/or Contractor) Br------------- -----(rtle] -------------- ------ � (Plot plan, showing si a of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). 401 FOR pEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- --------- ----------------------------------- DATE--------------------- REVIEWED -------------. .REVIEWED BY - ---------- ----------------- DATE-- ------------------------------------------------------- BUILDING ------------ -- ----- - - -- -------- ---- ---------------- BUILDING PERMIT ISSUED------------------- ------------------ - ------------ DATE------------------------------ Alterations and/or recommendations:.-------- �� .f tr' --------------------------------------------------------------------------- k ` } L \.� FINAL INSPECTION BY:.......24�... Date -------------------------- E. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RCO. 4