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------------ ------------------ --- -------- - - - -- --------- ~ APPL1CArro �--- h --------- AOR SANITATION -------- -- - (Com e) PERMIT Application is here-- " This Perini+ Fx plate in Duplicate) Permit This application ism�e made to they F iris 1`Year From D No. in co San .oaqurn Loca! ate Issued >rrplrance with County Health District for pate Issued JOB ADDRESS AN tY Ordinance No. permit to LOCArIQ f 549, ! construct and install the work herein described Owner's N-----'-�"�--_.4�._�- arne•. ------ -- Address._"-- ----- ---- ' Contractor'same - Installation will serve: --- ho Residence -- •------------ -----_ ----- . " Number of livin Apartment House - __ Number Su g units: --r--- Number Commercial ------ Phone--------Public of bedrooms . ❑ Trailer Court -0 77 Character o{ system Com J-- Number ❑ Motel soil to inanity system of baths -__L__ Lot size ___1 ❑ Other ❑ Previous a depth of 3 fee+:i Sand ❑ Privateepth to Water �� ........... I /"- Application " " ❑ Gravel Table " "" Made: (If es d Y ate_._: ❑ Sandy Loam --- ft. TYPE OF INSTALLATIONNew ❑ Clay Loam ❑ Clay (No se AND 5PECIFlC 1 No ❑ Adobe septic tank or ATIONS; Construction; Yes Hardpan Septic Tank: cesspool permit+ed if NO ❑ FHA/VA.. Distance from public sewer is ClYes ❑ No Clj iL11 nearest w available within 2pp fee+.) T` No. of well �_�_?p Distance from Disposal Field: compartments_--_-~lam m foundation- Distance from --------------------Size._ _ ------Mater- 1-" nearest w `•s---�Y- X ._Lig /2 Liquid ale • Number of lines------------well -1`'-Dd_' depth -- -- --- Distance fro Type of filter Length m foundation_-"-, Capacity" per--_ material__-- g Of each fine---- - Distance to eep�e Pit: Distance to nearest;welt" ""4"� /LDe th nearest lot line-_!may_ p of.filter _�"--- -- - --Width of � material,_-_-- trench---------- Number o{ --- Distance from 1"- ..... --.Total length- ----- --- prts----- m foundation__ -----`-- -i--•-- �Gesspool: - -- ---Lining rna#aria!__--- _ . ❑ Distance from .__-_._•_-----..Distance to nearest lot line_ ----- nearest well__ .; Size: Diameter___- De Size: Diameter---------- Distance from foundation:---4 ., Privy:- ----- -De 4 Depth-.. ❑ Distance from pth---- .�,,--- Linin nearest well--------------- F g material----- Distance to nearest !ot line -- - -- ------ - - LiquidCapacity. ----------- - ---Distance frani nearest building Remodeling and/or re 2 � - -- ---------- -- ----- -- - -----�---2� re" --gals, repairing -`--- g (descrrbe�. -------- --------- ---- - fhere--- -----------------•-•E - . ------ - th ----------------- ordinan Y at I have ~+ , . , - ces, State prepared ------------------R-- _ t __ ..-- - -- ------------ and a _ and rules Pplication and that the work will be done in accordance n regulations of the San,,ioeq --------------------------- ------------- - Si9ned)-•----- �� urn Local Health District. ---------------------- ----------- - �r with an BY:--------- - ----- -- Joaquin Count it $ J ------ Y Plot � ''� - -,----- - plan, showin ` g size of lot, location of s s+e �O ner r ----- ----------------- ----- and/or Contractor) Y in relation,to wells,,buildin s, (Title)""- 70 - g etc., can be Q•- ¢ placed on reverse side). OR DEPARTMENT USE ON Y kPPLlCgT10N ACCEPTED 8Y_._ EVIEWED BY-- -------------- ILDING PERMIT ISSUED------ ----_ - Iterations and/ - - -------- ------ = - - - ----- ------ DATE------- � --- ---- --- ----- or recommendations:_--_--- ------------------------------------................--- ------------ ---- • DATE- ----- cl -------- DATE -------- _ ---------------------------------- --- �- - ---- 'y INSPECTION BY:-�� - - '� -�,".�" ur � - - -- --------- ---�- - - -- --- -- -- ---- ------ HDate �.... ¢ ------- SAN 1601F. JOAQUIN . LOCAL HEALTH DlSTRlCT - - ----- -- --- -- -- ------- - - - ------------ stockton,California 300 West Oak Street Lodi,Caiifornra 124 Sycamore EO B-5B $M 3- street 63 MatlteCo, 205 West 9th ' California Street � Tracy,California i