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'~^OFFICE— USE: ~ Permit No APPLICATION SANITATIONPERMIT ! lete in Duplicate) y7 ` Date Issued ---- 4 . � Application is hereby made tothe San Joaquin Local Health District for u permit to construct and install the work ha,ein o��- | This application is made in compliance ~�hCounty Ordinance No. 549. m = I+,4--1y � ) / / �- - -��c��cx�'-.s~w�+._-___-- � �� ! ' {}wno/, Name�-_-x�k��`_.--��A_��y�yl-��l.--_--__---.----------_-----' rno":-��.^^ ' - . � noo' ---------------------- Contractor's Name----. ' .__I__ ------------------------------_____ -------- Installation .' |nstallation "ill serve: Residence [a Apartment House [:1 Commercial [] Trailer Court [:] Motel [] Other E] � Number ofliving unit,: -) -' Number ofbedrooms -(3. Number of baths Lot size -------- �x��-.u��*x~�x�-----.-- / Va+er Supply; Public system R Community system [] Private Dtr Depth to Water Table &°- ft. Character of ,pi| fp a depth wf3 feet: Sand-mM Gravel [] Sandy Loam [] Clay Loam [] Clay [] Adobe C] Hardpan [] ' Previous Application Made: (if yos'6oto------------ ------- ��) NoNow Construction: Yo,'V No E] FHA/VA. Yes [] No TYPE OFINSTALLATION AND SPECIFICATIONS: (No ,npfic tank on cesspool permitted if public sewer is available within 200 feet.) | Septic Tank: Distance from nearest well ~- � ,-Distance from foundation--/��.^ --��o�r)| ��----- U 4 No. ofcompartments------'~�~------------Size---�f.y_ur_x---��._-Liquid depth----_.V.�---------Copocity..Z7_,PP-.S�T I- � � Disos | Field: Distance from nearest well 6 -'-.-Distance from foundation-------!-4?.......Distance to nearest lot Number of lines--�'��.---'--------Length of each line---------- -0!------------Width oftrench Tvpa of fi|+o, mutorioL ---Depth of filter material -..1.8.........Total - � Seepage Pit: Distance to nearest well ---','_Distance from foundation Distance to nearest lot line---------.- [] Number of pits----------------------Lining material --- -----------Size: Diameter---,-------Depth------ ---------------------- - � Distance from nearestw�L---''-D�fonco �om foundot�n--_'''-�ning mbfo�uL-''''----''-'-_ � ` Size: Diameter Depth \ Liquid Co i - -~ - Distance from �, ��|| - ' Distancefnm� nou�, building-. P,�y rmnc� nearest �` _- 71 Distance to '--- lot - -------'----------------- ------- ' Rvmo6eling and/or repairing (describe):----------- ... -__----___..----__----- . ______..-____'_---_-___-----__--_''�-��'------'�'--'--'----'-'_---'-----------' ! ^ , - ~ _ / . .--.--__-_..--� _��----_-_-__---._---_-'��_---_. � ° ~` | hereby certify thatl have prepared this application and that the work will be done in accordance with San Joaquin / ordinances, -State laws and regulations of reguons c� +ho �an Joaquin �p�uHealtDistrict.* DistDistrict./� � . . and/or��nod�-_..oz-��.^ -..��-=~��~�~~-�-^�,�°*~=^-'.-- Contractor)" ----'---''-----'--'--'--^- '--'-------------- ! ��f plan,' showing size, of lot �'of in relation to wells, buildings, n+c.. can 6e placed on reverse side). �. FOR DEPARTMENT USE ONLY � \ / APPLICATION ACCEPTED BY----------------- --------------------------------------------------------- ------------------- REV|EVYBD DY----------------------------------------------- DU|LD|N(� PERMIT |S3UED-___-_-._----'' | _ ' . _ /'�� ��e,��n� and/or �_--------'r'-------------'-'-----'--------'-------'---- | ----------------- --------------'-'--'---'------' ] ----''----_--_''-----_---_-'''---_- ---_' .` ----._---_--._._-___--.------------------..---_-.-.--__-----_.---._-----_---.. -'',--'-----^- ~- -------------------------------------------------- ------------------------------ -------- --------------- ------------- ----------------------- ------------------- ------ -------,'_--------'_._- � - '--_-'- ------------------------------------------ ---_ ------- -'-' r --- -------- FINAL INSPECTION BY:. ' - —' !-��--'-'- Date_..--------- -/c' �,�-'---^�� ---- SAN JOAQ0N LOCAL HEALTH DISTRICT . 1601 E.Hazelton Ave. 300 West Oak Street 1o*Sycamore Street 205 West 9th Street Stockton,California Lodi,California "~ � Manteca,California Tracy,California a" ° REVISED B-59 3M 3-'63 "p=".