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FOR OFFICE USE: <br /> 15 <br /> -------I...... APPLICATION FOR SANITATION PERMIT Permit No. 4 <br /> 1 <br /> -pplication is hereby made t6 the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> _This application is made in compliance with County inancr No.'549. <br /> O8 ANDcz_� 1 <br /> ' <br /> .-~. ' Name__-_�_.__-__-_ <br /> Address. ...... 1gl <br /> . Phou�'''_---'---�'- ' <br /> Contractor's Nume--"--­--Aa�cz-- _.____. � <br /> Motel Other [] , <br /> .~.~.~tion_ 'ill- serve: Residence_ ~~ . -- � ~ ^ <br /> --- <br /> Number of living mdh^: ^"- Number of bedrooms ��.. Nvm6ar '--'-'' <br /> Water Supply: P�� ��m [] Community system `� E] Depth toW�e T�o �� �� � <br /> ' ' 'Character of soil to a depth of 3 f66+' °Sd~ Gravel [] Sandy Loam El Qlay Loam [] Clay [] Adobe0 "Vurdpan �l � <br /> Yes gg--No C3 <br /> Previous Application Made: (If yes,date----------v---------) No Z?' Now Construction,)Yes @?'No [] FHA/VA <br /> TYPE OF INSTALLATION AND SPEC IFICATIONS: 0 feet.) A—) <br /> (No sopfic tank or cesspool permitted if public sewer is available within 20 <br /> Septic Tank: Distance from nearest well-,--—------I-Distayne f om foundation---le-------- <br /> No. of compartme Liquid <br /> Dis Field: Distance from nearest well-*----—--------Distance from foundation.-40-1. ,pistance to nearest lot line­blf�-.�...... <br /> Number of lines.- -------- Z---Width of trench 01 <br /> Type of filter rnaterial.& o-Depth of filter material--Ae--!!!?�. 40, <br /> See ag Pit: Distance to nearest well-7 -: Distance f;9m fovdation_-,oe��­'P­­Distance to nearest lot line- ------------- <br /> El. Size. <br /> Privy: Distance from nearest ------..----.�..'--'Distance from nmorosrouop."y---.---.-.-------- <br /> � ' ^ <br /> Distance to nearestlot line--------------- __^_ ____._ ------------------ ..________ <br /> Remodeling and/or repairing �e,c�b��'---+«x���^��.. -_-____._________ <br />� '-'-__-�--_.-'-__---__-''-_---_.'-__-`-_.---_�--__.'-_-'''-�`--_'__-_'''-''-''--_---.--_.---- <br />� ._--.._---.-----.-_-_--------------.-.__-_-----_----...__..---.__--._-____''''.-_---'--- � <br /> --. '_-__.----_-.--_--�..--'--.----.----_-._------.----'__---_-__----__----. , <br /> ---'---'----'--�hereby certify hat'' | 6 ^' d +h�'application 6 that the work will be done in accordance with San Joaquin County » <br />� nndm="="s, "'~'e laws, and rules -- regulations— of the San Joaquin <br /> ^ � <br /> By:. �v*��` ,�af�� ��^ bundmg� sf�. placed on reverse side). <br /> (Plot plan, showing size of lot, location of ' - <br /> FOR DEPARTMENT U NLY <br /> ATE <br />/ .~.~'.NG PERMIT ISSUED L -' <br />� - <br /> Alterations and/or recommendations ---- --- <br /> ../m��-__.+'�u~^*�--~`"°=~�~~~�~~.~~ _ _ <br /> __ -. ________---------------------- ---------- -------- ___---_^___ <br />. <br /> ..........---------------~............................................................................ <br /> � <br /> ---------------------------------------- .-'''^--------------- --------------------------------------------------------------------------------'_--------------------------------------------------------------- <br /> � -��� <br /> NAL INSPECTION BY:.. ----_.----. Date------ <br /> � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ^u �=� - ` \ ��� � ` ~ ` � cv��°m�m�=° <br /> 130 South xmww"�.e�w ,««W** »r** °�~~~~~'~~ ` ' <br /> ' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> _ <br /> "k 9 REVISED *1-89 o1A ^'mATLAS <br />