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- AMICATION FOR SANITATION PEM[T Permit No. (Complete in Duplicate)' Do+e /,,uoJ ~- is hereby made to the Son Joaquin Local Hau|+h District for n permit foconstruct and install the work herein described. This application is m*6o /n compliance with County Ordinance No. 549. JOBA �� -- _-,__-'.~---.. - ------------------------------------------ ------------------- ------------------------------------------- Owner's Na /-----�-' ------------' ph»n»' �'-a"?'"^4----' A66no,�----��lZ^--'�f�.��--- -- Contractor's Nomo~e,-;?-��.��--------------------------------- --------------- --------------------------------------------------------- ------- Phone-_.-____.__- |nvtaUa+ionwill serve: Residence �j Apartment House [] Commercial [] Trailer Court [] Motel [] Other [] Num6orof |i*ing units: °(-.. Number ofbedrooms �-' Number of 6o+h, -I---- Lot size _, ..��u�wu*��----_-'----__ _ ' Water Supply: Public system 0 Community system ID Private M Depth to VYu+u, Table ........ ft. Character of ,vi| to a depth of feet: 3unJ [] Gravel [] Sandy Loam,-M Clay Loam [] Clay F] Adobe E] Hardpan [] -- p,evinv, Application Made: Yes E] NoZ New Construction: Ye, �q No [] �~ TYPE OF INSTALLATION AND SPECIFICATIONS: (Nn septic tank or cesspool permitted if public sewer ivavailable within 200 feet.) � �� Septic Tank: Distance from nearest well. --D�+once from fouo6ution.;-.�?'�-_-k4oferioL ��-- �� No. ofcompu�montc--�=------Size2- '� -z---Liqui6 6eptk--��-�----.-Capacity--- Disposal Field: Distance from neare ~o|L^/0-_%-------Distance from fo 6- 3-q^ ' Distance- Number of lines.--'- .'_ . Length of each line, V i6H` of trench ° Type of filter mufo,i* ...Depth of fi|tn, muferioL'/1?-°-._Totu| length---1]��.�'-____.-__ Saopuge Rt: Distance to nnom, well--- from foundation------------------Distance fo nearest lot line,--_-- - n Number of pits----------------------Lining material------------ Diametoc'-'----Depth_ '_-'---'-- CesspooL Distance from nearest well-----------------Distance from foundation... ............... Lining moterioL-------_-'__ ~~ [] Size: Diameter --------------- -----------------Depth--------- -------------------- -------------- ------Liquid CupucHY.'-'-_--. Privy: Distance from nearest well -...... --------------------------------------Distance from nearest building-----------'--.-___---- 0 Distance to nearest lot |ino''---'----''_--------_-------_-._-_--__---_-------� � Remodeling and/or repairing (describe):---_'__-__-_ _____ - ---------_-_-'-_----_'-----_--_----_--.-'._-'_____----_-'-----_--__---.-.----'---_.-----._-._-- ---'----'-'---------'-'-'-------------------------'------------------'------------'------'----' -- --'---'--'----------------------'---'-----------------'--------'-------'_----- r w | hereby certify that 7 heveprepared this plication and that the work will be done in accordance � � San Joaquin County ordinances, State laws, and rules and regulations of the Sun Joaquin Local Health District. -- (Sign 6 --------------------_----.(Owne, *nJ/p, Contractor) '- -`'------------------------'-`--'-------- --------- (Plot plan, showingyze of lot, location of system in relation to *n|ls. buildings, etc.. can be placed on reverse side). _ FOR DEPARTMENT USE ONLY -- REV|EWED BY - ------------------------------------------------------------------------------------------------------------ DATE------__---____________ OU|LD/NG PERMIT ISSUED--------------------------- ------------------------------------------------------------------------ DATE---_-------------__'__ AKe,a+ionsun6/o, ,ocommenJa6ons;------------------.-__----------.---__'__'--_-_---.-__-' Ao �r --- ~^ � ^�_ -`~-''------'--'---~--'---'v,--'—'----' '' -------------------------------- ~~ �r-----'��-'--' �--'-- ----------------' . Date INSPECTION 8Y /~ - SANJOAQU|N LOCAL HEALTH DISTRICT 130 South American s*"°+ 3ooWest Oak so°"+ /o Sycamore s*°° nw w"�� ^c,' s*°� . ~/ Stockton, California Lodi, California Manteca, California Tracy, California ^ _ "S-, .45446^,~OO"