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APPLICATION PORSANITATION PERMIT (Complete in Duplicate) 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.' �0� 7 JOB ADDRESS AND LOCATION_?_'"'" I - --------------- -------------------- Owner's t ---------------------------- Owner s Name---------- ---- --- ---------------------------- Address ------------------• - --------------------- I ---------------- P Address--------------------- --- bona ,.� -----� - �,`' �- -------------------- --------------------------------------------Name-- ,"- `" --------------------------------------------- ' Installation will serve: Residence Apartment House ----------------------------------- - --" - - - ----------------------- - Phone--------------- ----- -- ❑ Commercial ❑ Trailer Court [] Mo}r J Number of living units: ❑ Number of bedrooms ❑ Other ❑ -J Water Supply: Public system � Number of baths � Lot size________:v��C fQ C,1lit PP Y Y ❑ Community system Y Y ❑ Private _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand L � Sandy Clay Loam.❑ Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: Distance'-from nearest well7•.3 Distance from foundation-----1 -------.Material_-_:___�-Bit_-� t X No. of compartments-----------2-_.--""-Ca acit -------� 1 Cess ool: Capacity Size__ _- iG- ------Liquid depth-------2+�_ '`-p___ 1S__ ❑p Distance from nearest well-____------_ ---Distance from foundation -----.Lining material------------------------ Size: Diameter---------------------- --" - -- ------ Depth------------------------------- ------ -- ------------ Priv -------- ,Y� Distance from nearest well_ _ ------------------------Distance from nearest building Disfiance to nearest lot line___._"-- g _..--___-_-_ Sr ---------- eepage Pit: _ Distance to nearest well------------------ - Distance from foundation______-,_.__ .- -. DNumber of Pits_____- ""-"- ""- "_Lining material"- ""_"-_ _.- "- _ Size: Diameter" Distance to nearest lot line-___ ispos *Field: .:= Distance<from;nearest well 'y!f� - Depth------------ --------- ""-_"-_- ----- --- ------- -----Distance fro . oundai,ion=fes- ` ;- Distance.:#o_nsarestJot �f Number of linas � _-" Length of ` / ------ - Width of trench Type of filter materiaL_� �h_---- Depth--------- of filter material /r. Remodeling and/or repairing (describe):______-__" --- ed this ----------------------- I hereby certify that I have prepa; application and that the work be done in accordance SJoaquin Count -----------------will---------------------------- with an __ _ ______ or inances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ........ Com.tx- J ------------------------------------------------------------ --- -------------------- 1 Contractor) By:___""___--"-___"-_""-_"__"""-_"-- " - (Owner and/or (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be fried wit } ----(Title)--------- ' h this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______ "-___ REVIEWED BY-------------------- - DATE__ r ------------------------------------------------ UILDING PERMIT ISSUED--- ------------- ----- - -- - ---- ------ -------- ------------------------------------------ DATE----------------------- Alf --------------- - ----- ------ -------- - ------------------------------------ DATE--------------------------- erations and/or recommendations:-_____- ------------- I -------------------------- ----------------- - ------------------------------- - ------------------ - ------------------ -------------------------------------------------------------------- ` - ------------ - PERMIT No._�'/-` // -- ----- -------------- - ------ - ISSUED_----�----��`--r----- --- (Date) FINAL INSPECTION ��_' i -------------------- Date ---------- .^ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9--2M 9-50 W=1639 Stockton, California