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FUROFFICE USE: ----------------- y -- -- ---- ___ APPLIcATION FOR SANITATION' `:RMIT Permit No. ------------ (Complete in Duplicate) --- ---- 'd-----------"" --- This 6 mit Expires 1 Year From Date Issued Date Issued 751116_ „C Application is hereby made to the San Joaquin 'Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance tjo.,59. JOB ADDRESS AND LOCATION.- 7� :Y /” �� 1 ,� s..,•e -tee--- Owner's Name-----..�� ---------------------------- ;--------------- .......-•------------ ---- ------------ Phone./Y(� 20-1.67.2— Address---- Contractor's -------------------------- Contractor's Name__.______""••- -_--_ --l� ------ Phone................................... Installation will serve: ,$e�idP�c� rt PV,n�0ous Com ercial Q t I , ► ❑ Trailer Court ❑ Motel ❑ Other l�C4sv' Number of living units. -------- Number of bedrooms --------- umb�r of baths -------- Lot size --_•_____________________•-. C� ` __________.________.-._ s�--- Water $uPP Yw' Pu1 - Evtnmu .,. ,_ *• e to Water Table ft. � T Di+izT' Character of soil to aef $eet: 'Sarfid ( ' `'GRaveel ❑ Sandy Lo' Cla Loam Ado _ - Y y ❑ be❑ Hardpan ❑ a ...� .. _._. m- ._. .. . 1 Previous Application Made- Of yes,date_'___ _"Ko Ko J� :i" �ructi n: Yes 1 FHA/VA: Yes ❑ No�' TYPE OF INSTALLATIONAND SP TIQNS: _ (No septic tank or cesspool permute if I}ubli se N► mrgjlable�wihin 2 feeTT-11 ' � Septic Tank: Distance from"neai3P'tlbil._ fr undation___ 'j No. of+compartments____ _' ' Size__ ielf&;-._�---Liquid dem�}},, Disposal Field: Distand from,neares ..well_ •�}�1!_-Distance f .founatio .�tl --'6listance to nearest lot line_________________ dumber of.:l�rs_ __ Len ach line 60 ` ` iill /dth of trench_-- ,..i , Ty` of.flfac.;rraa#ec "� ------ - -•_QP , of ma erialt _Wj,tal length------/ &2----- -------- --------- Jar6 ❑ sf well__-__+_�___________Distance 'om foundation...................Seepage Pit: s an Number of pits_ Distance to nearest lot line__.____.___.__.._ - ningmat� -------_------------Size: Diameter------ ePth Cesspool: Distance from foundation.----------------- ,_...�t�pt,c�e...A•�°►.nea�re51'x'14"'= ----------- a : j,mW mate al---------------------------------- Size: Diameter. Depth -•-- --- -Liquid •--•--•---•----•-..-.....gals. j: ivy: Distance from nearest well _ _________ Distance *In nearest building _Distapee,iso nearest lot line-____-- _-- RiIin�GIdoling and/or r paringrihe�------ `- r� --------------------- - ----- -------------------------------- ---- ----- ------------- ..----- -19;14_ -:y'n'*moi"' + -------------------------------------------- s + hereby certify that I have pre recd #led ap icatidwand that the work will be done in accordanc;4 w*h'San Jo4quin County ordinances, Statp.l.�w� regul ions of S Joaquin Local Health District. .( igrmd) < r` , tract By,:_.Y.._ t ' - or) -- ----- --- ski n+n IPlot Ian, showin size of I $� }'- '� * ---- ----- P g a> o$btMyi o�'�y�t m�in relation to wells, buildings, etc„ can placed on reverse s l) RTMENT USE ONLY APPLICATION ACCEPTEDUIOO ` ` �' ' "' `• ------- , rL+ 7-; V. REVIEWED BY--•- --•---. . 1 -------- BUILDING PERMIT ISSUED------------------ w = r4�. Alterations and/or recommendations•__- i �` ►+�� � _ . - .. x ------------- a.� ..rare k ` \ ,.. - .� ;.. __ "-� .'-rd- - ,.4.t --•-�,+.:y,•J ^, •�,-) ••,... a -.-•-------- FINAL INSPECTION BY:--- :, s• ,:r,R.': t ---------------- Date... ----------- --- ,.t 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California -w Lodi,California Manteca,California Tracy,California E6•9 REVIe EC 8.59 F.P.0 O.2M 6.60