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lh Permi APPLICATION FOR SANITATION PERMIT No ....1_.P_l-s�-. {Co ple#e9!n Duplicate)_ ll f _'w a - Date Issued _ Application is hereby made to the an Joaquin Local Health District for permit to construct and install the work herein described. This application .is made.in compliance with County Ordinance No. 549. - ADDRESS AND LOCATION_________ ---- ' ---- --- -------- ----- --- ---- ------ JOB - - - Owner's Nam - - - _. -- yy Phon r i Address---- --------- --------------- ------------------- T_ - t rt o Contractors Name- ---- ------ I 4 Installation will serve: Residence Apartmen+ House ❑ Commerciali ❑ TraileriCoert ❑ Motel ❑.�Othe�❑ t i /---,L !1 i �_'__ Number of bedrodms Number of baths ! _= Lot size _-- - - •9---------- Number of living units _ 1 � Y ; Water Supply: -Public system a'�Comm nity'system ❑ Private'�Depth to Water Tab4e.;�.,`_�ft. iP ` y L] Sandy Loa ❑ Clay,Loam�:❑ ay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel • � Il Previous Application Mader Yes ::1 No 911-"New Construction ,Yes E No �FHA%VA; Yes ❑ No {-t TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or'cesspool permitted if,pu6lic sewer-is;avadable within 200 feet-) E i k:� Distance fro nearest well _ Distance from foundation. .Material _--____ J__ ------------------------------ k, ----. No. of compartments-- -- __-:-� -----._Size- ---- l _-- Lsquid„dap h--------------- Capacity Disposal Id: Distance fro nearest 'well--- _____Distance from foundation__c�� . ----Distance to nearest lot her_ ? I _ ___--------_ -Len th of each life____-_-. --- .---Width,of trench +� �---------- {-- Type of of.lileer es_____a-_-� erial_.. 9_........Total length_=:_ _—.5 --------------------- i - -------- ---- Type of filter material=-��_ Depth of fi4ter mat S1i�l See a e t: Nlumabe�of n'+ares+ well n -rr�DteJn'rial e� -m f ndation__ ___..Distaice_to nearEst lot line__ p� ”. i G` Size: Diameter- Depth - .Q Cesspool: Distance from nearest well_=__:___-_____:_Distance from foundation____`--- _------ .Lining material_ __________________. _ rr ❑ I - '---Liquid Capaeit ---- ---- gals Privy: Distance amefrom r.nearest,well__'_ De: Distance from earest building____--____' _:_'._�____--.-----� ❑ Distance to nearest lot fine_'-__ _::_� �. : �_.. % - - - L I . i PRemodeling and/or repairing (describe)-----= -- -- ---- __-------------------------- ____ _____________ ____________ _ _ +"',rte` _ _ __ -------- _. _ _ ___ -- E hereby ►f +hat I have p 1 , i sw = yF - �; - .. y y repared this application and That the work writ be done in accordance with San Joaquin ounty ordinances, Waews, d rules r'egulations f the San'J quin-Locel"Heal+h District.Si ned 7- ----- caner r Con+rector]9 )------ P_,svoe'r�, 13 e , 7dn --- =Y:_- ------------- , etc. c n bele aced'on reverse d1e(Plot plan, showing size of lot, location a `in relation tow plk1FOR DEPART ENY , APPLICATION ACCEPTED BY------- --------- � ---------------------------------------- -:-:-.DATE -•------ ` REVIEWED BY--------=----- - =- ----------------- --------------- DATE BUILDING PERMIT ISSUED------- ---- ---- ----------------------- DATE Alterations and/or recommendations-------------------___ __ ------------- ------ I ----------------- j _- -{ - _ --- - - ---- - ----•------ --- •--- �• r 1 --- - ---- -------------- T------ -------- - C_ - ---------- --- ----- - t FINAL INSPECTION BY:--- .==-- Date_= = -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M Revises 1-57 FY CO.