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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ' Do+o Issued . . Application is hena6v made to the Sun Joaquin Local Health District for °po,mit to construct and Vst'o^U�-- ' herein described.This application is made in compliance with County Ordinance No. 549, | | Owner's Name---- --- - ----------- ;-14.---:-:---Z--- ---------- ----------- --------------------------------------------------- Phone----------------------------------- |n»tx|la+ion will serve: Residence Apartment House Commercial F] Trailer Court E] Motel [] Other [� Number ofliving units: ..l�.. Number of bedrooms '�_. Number of 6u+h, -l-. Lot ��n.��1�..4U.��-------------' N/mfe, Supply: Public system X Community system [] Private E] Depth to Wafer Table -------- ft Character of s6| to a depth of feet: Sand [] Gnuvc| [-] Sandy Loom E] Clay Loam R Clay [:] AdobeI-] Hardpan [] Previous Application Made: Yes [] No �� New ^ .Yoo�� No FHA/VA: No -^ .-- . _ r< TYPE OF INSTALLATION AND SPECIFICATIONS: x� (No septic tank,wr`cwoapmwlpermitted |fpublic sewer isavailable within 20Df*et) �� U Septic Tank: ��,t�oca from noor�s* "v|| Distance from foundation ��turio| ' '-----' ------- --'--------'----'-- { [] No. ofcompartments---------- ---------------Size---------------------------- ---Liquid 6eA+h--------------------------Capacity-----------.. Dispusa| Rv|6: Distance from nearest weU-JA'-�,-Distance from foundation---� m--_'Distance to nearest lot line--��. 8� ker /' / ;�!� + Seepage Pit: Distance to nearest we�Lbf-—-------------Dilanie f o foundation----1-Q----------Distance fo nearest lot Jine----S-- ------------- nemvd:wng ono/pr repairing (oescnue):------------------------------------------------------------------------------------- ------_------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ---__------'----_'_____--------_----' ___________________________----___________________________-______:-_'`___________--'__'___'' --''-''--'''----'-''--^'--'''''---------''''----''---------'''-----'--'---''-------''--'-'--' hereby ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- ---------------------------(Owner and/or Cpntrmc+n,j 8� By:--------------- /---------------------------------------------------------------------------------------------Title)--_-----._--_----------------------- (Plot plan, showing -_._--(Plotolan. showing size of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED ---------------------------------------------------------- DATE- RGV|E\�B] BY----------------------------------------- DATE--._---'_-________.. BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE ----_.-�-----_-__-- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------- ---'-'--'''-'''-_-''-'''-''---'�'�_'-''--'--__-''--_-''-_''-'''-__.----'-'-_--.'_--' .__--_._-_-_.----__-_------_-__--_--__-__--_-_-._-____'_--_--_-__-_.-_.. _____________________________^_______��- --------__�_________________________________________________ ''�--'-'--''---''''-''--'''''---'�_��'''''''-''''-_.-'-',--__-'''-'''--''�-��'-''''''-''--''--''--- FINAL INSPECTION '—''--'-'- Dut,'-r� --x-------''~� --------------------------------------------- SAN -''''-''-'-''--'�'__S/kN JOAQU0N LOCAL HEALTH DISTRICT � /sm South American Street 300 West Oak Street oz Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California '1 ES-9-2 M Revised 1.57 FRC0-