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FOR OFFICE USE: ��T\�� N� - ^��'�'�� n Duplicate) ,--/ Date Issued Application is hereby made to the Sun Joaquin Local Health District for u permit to omstmd and install the work herein described. This application /smade in compliance with County Ordinance No. 549 JOB ADDRESS /N-�J�`�-'�� ....... ��]� �-'----. '----'------- W Phone-!!;-. Contractor's Nar i f Installation will serve: Residence 54 OApartment House E] Commercial E] Trailer Court E] Motel E] Other E] Number of living units: #2 N mber of bedrooms A2.. Number of baths -a_ Lot size --- ---------------- Water Supply: Public system ;o �Communify system E] Private [:] Depth to Water Table .&Oft. Character of soil to a depth of 3 feet- Sand E] Gravel [] Sandy Loam [] Clay Loam I] Clay El Adobe Ul"Hardpan El Previous Application Made: (|fvoo.dote ) No [] New Construction: Yes [l No �� FHA/VA.Yes E] No�� TYPE OF INSTALLATION AND SPECIFICATIONS:' ^ (No septic tank or *wopow| permitted /f public sewer is available within 200 feet.) S TOM Distance from nearest well----. ------------ from foundation ------ MotariuL---------------.. No. of compartments -----' ---- Size -------------------------------- Liquid 6 -------Cupocihy-------' ` Distance from nearestwell0tt-Iti—eDidafrom foundation. -.-I 0 " Distance to nearest lot line Number of lines --- ' ^'~'~Lengthe..-�Y'---' '\ ,r` `' ^^~''~' �"p". u. n.,vr mur�nu/ »�� /o�/ length Hf: Distance to nearest ~e|NK��.VDistance from Num6er of pits... K' ....... 'Lining material R 0�� Size: DiomofocDopf6-- QS_ - .'--- Cosspoo|: Distance from nearest well -----.Didnnco from fomn6o6on-----. Lining material ----------... F] Size: Diameter ' ----' ................ Depth ..... --------- .................. -------- .... Liquid Capacity ---------------------------- gals. Privy: Distance from nearest ~e|L_.................................. ... 'Distance from nearest building __ ----------------------------------- I] --------'[] Distance to nearest lot line - -_-----.--' --------'-'_-'_-----_-'-----' -- Remodeling and/or repairing (describe) -------- .��~ �� -'' —-'-'- '------------'------ '' ---' -�~� -'. ^��m ,�a� ---u��-.x��------. --------'-------'--''--'-----'-'--"---'-----''---._---------------------------------------------------------- --_-_--- ----------''-'----' _-------------------------------------------------------------- ----------------------------------- ----- ---------------- ---- � | hereby certify that I have prepared this application and that the work will be done in accordance/ ordinances, State law- _- rules_ _- regulations ` � (Plot plan, showing size of lot, location of system in relation wells, bu ding e ., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION DATE '—' ^~ -� .......��__'-_-__--___'_-'REY|EWED 8Y--. —.D�TE'- OU|LD|NGPERMF[|SSUBD ,./ ----'--'--------''-----'DgE.- Alterations and/or -------�''.��''>---- ---..�-- _ _ ' ----�/ - �� -,^ ^~ � .-_'-'�' -----------^---------------_-------------------_-.-----'_-.-'A---_'_--- '---''----------------------------'—'--'-'-----''-----------------'--'- -_------------� ---'--'----'------_---------'---'--.--- -------- FINAL INSPECTION BY: Do+o-' ----NJ��U|NL�CALH6ALTHO/6T@CT --'_---' 1601 E.o"xe»°"Ave. »ooWest Oak Street 1o*Sycamore Street *mWest 9th Street Stockton, California Lodi, California Manteca, California Tracy, California "=co.