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CATION FOR SANITATION PE MIT Permit No. --- -------------- (Comwplefe in Duplicate) Date Issued ---------- Application'is hereby made to the San Joaquin Local Health District for a permit to construct and install 41 work herein described. This application is made incompliance -with County Ordinance No. 542. " JOB ADDRESS ANI) LOCATION_ ... 4 Owner's Name ------- ----- --- -- -------- Phone -------------- -------- -------- - ------ ------------------------------- — ---------- ------------------------------------- .......... ------- ------ ---------------------------- ---- -------------- Address-----•-•----- ------ -------- ------------------ ------------------------------------------------------------------------------------------------- Contractor's Name. -- ------- - - ---------------- -------------------------------------------------------- Phone_,1jW___ 1_t4�e7 partmenf House' 0 Commercial [] Trailer Court [] Motel L] Other Installation will serve:! Resiclence'ff, A E] Number of bedrooms Number of baths Number of living units: /.Lot size ------------------ Water 'Supply: - Public system El 7Community system E] Private 9?-Oepfk to'Water Tables�_- ft. Character of soil to a' de -p th6f 3 feet: Sand F Gravel E] Sandy Loam E] Clay Loam E] Clay El Adobe ,.Z- Hardpan El Previous Application Made: Yes [] No X New Construction: Yes'E] No FHA/VA: Yes E No E] IF TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or: �cesspool permitted if public sewer is available 'within 200 feet.) S Distance from nearest well ---------------- b- Distance from foundation ------------------- Material , 4^ No. - -------------- ........... No. of compa'rtments ------ ------------------- Size --------------------------------- Liquid depO ------- : ------------------ Capacity ----------------------- of Disposal Fi lcl:N�Distance from nearest well--.4te ----- Distance from fourclafion--o'70! ------ Distance to nearest lot line -,s---------v ------- Number of lines__.'__ - / . Length `of each .line______ .S7- a- / I ---- -- ;- ____ 4 --- ------------ Width of trench ---- A Type of filter maf�rial --- Depth of filter material ------ - ---------- Total lengfh-1 A47 b 14i:., — . ------------------------------ s.pnce is ance L�nearest lot line _U N 6 m be"r aterial ; ---------------- Seepag,��- Di f fj nearest w';11_ .__--Distance Distqnc�'fo of pits.-.,-/ ------------ Lining �n Size: Diameter ------ iU ---------- Depth ---.-?- ------------ Cesspool. Distancia from , nearest well_-_ -- ------------- Distance at ion --------------------- Linirig material____.--___________---_ El. Size. Diameter -------------------- ------------- Depf h ------ --------------------------------------------- Liquid Capacity----------- •---------------- gals. Privy# Distance from nearest well------- , 0 ---------------- Distance from nearesf building!_.----_---------------•-------_ -------- Distance to nearest lot ---------- ----------------------------------- ----- Remodeling and/or repdiiing (describe):- ------------------------------------ ------------------ �' " r --------------------------------- . J. ----- - --------- ---------------- ---- ---- ------ b -- ----------- ----------------------------------- ------------- ---------------------- ------------ --------------- -------- j — - -------- I ------- ------------------------------------------------------ ----------------------------------- --------- * -- — ----------- -------- :1 ---- --------------------------------------------------------------------- ---- ----- --------------------- ------------------------- --------------------------------------- ------ --------------------------------------- I S r hereby certify that I have prepare f islapplicafion and that +he work will be done in accordance_wifh San.Joaquin County ordinances, Sfafx.--,,.an--F'ules-anUe ulations.he-Z ,of-tan—loaquin Local Health District, v d 9 ----- - -- ---- (Signed) --- ----.j.--- -- ------ - --------------- --------------------------------------- I --------------------------------------------------- Owner and/or Contractor) By; --------- ---------- t 0 - -AL --------•----------- - ---------------- sy In. e I"f ion to 411s, buildings etc:, can be plated on reverse side).* (Plot plan, showing size of lot, locatioin�o ffiflel --------------- ------- 4s ,IFQR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------------- ------------ --------------------- REVIEWED BY ---------- L - - , . I—- - ------ DATE. ----- -------------- ---------- 5 --- ---------------- -------------------------- --- DATE! ------- 'i --------------------------------------- 7 -------------------- ------ ------- -------------------- ------- BUILDING PERMIT ISSUED ---------------- ---------------------------------------------------------------- r DATE.-------- - Alterations and/or, recommendations:.-- ----------- ------------- - -------------- * ---------- --- ---------------- ---------- - ----- ------------------------------------------------- * --------------------------------------------------- ; - ------ ------------------------ ------------------- r -------------------------------- _ ----------------------- * ------------------------------------------------------------------------------- ---------- --------------- ------------------- ---------- I -------------- I ------------------------------------------------------------- FINAL INSPECTION- BY:__Wa7`- ------------------------ Dafe....2/_� ------------------------------- 2 ---------------------- 130 South American Street Stockton, California ES -9-21x1 Rey4ea 1-57 F.P,CO. .SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West 46. Oak Street 132 5,camora,11r..t 814 North "C" Street Lodi, C, alifornia Manteca, California Tracy. California