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Permit No. ... . .-`APPLICATION FOR SANITATION PERMIT--------- ?` " (Complete in Duplicate) Date Issued --� ---- ----- ------ Application is hereby made to the San Joaq m Local Health District for a permit to con trust and install the work herein described. This application is made in compliance t ourjy rd�nce N . '49. JOB ADDRESS AND LOC 7f -•--- ------- • - �ti -�`� Owner's Name------ 11 .E Phone . --•-�---------------- - - ----- - ------------------- Address------ = ��1-3 !- •�� ------- Contracfior's Name `'. -------------------------------------------- Phone..-------•-------••------------ Installation will serve: Residence W<-A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units::,".,/-_ - r. g dumber of bedrooms -S_ Number of baths __2_ Lot size ------------------- ------ Water Supply: Public systerh- Community.system. Vk- Pnvate ❑ �Depfh to Water Table P-4t. Character of soil to a depth of 3 fi�f: n: ❑ Gavel �}'�;�findV.Loam ❑ Cldy Loam AddbpHardpan Previous Application Made:-.,Yes'❑ °Iy� New �Qnst uCt,p #� V4 TYPE OF INSTALLATION AND SPECIFlC,4T4�15:` 41 a [No septic tank or'cesspool.perrajSt#fedprE p11#liI sewer is available withrre 20Q feet.] f rt `s Septic Tank: Distance from n' dresr veli' ?�� Distant "f om fnarrdatForr7rs ..� A� f �/� Y_ [� dap ' __ Capa No' df.compartmettt5{. ✓-.' -tt i�Siae = ` Lii�uid city__ Disposal ield` Distance from nea�a vrelE _4 -We ��sta�i�e��r 4�r fl � �sjan�e.}p ned est �vt 13p�e -----_- _Plumber of lines--,--- -- ----- - --.fiseng `: freach�ine___ df ole TY'pe' of.filter material/t;_ Depth off# filter material-_-�1 _:__:-_---- .Total length-:--- :. Seepage Pit: Distance to nearest:well__________ _ Distance from ndation--- t ..:r.-_.Distaoe fo'nearest lot line___ ------- a-[ � Number of pits.-- -_-.-____._"Lining material___-Size: Diameter? -:___ {� -----..De th-----�ip- Cesspool:" Distance from nearest well---------- ---,Distance from foundation------------__.__.:Lininganaterial--._.__------,:_--"_.:___________.__--Ll'o Size:_Diameter-------------------------------------Depth-------_-- =-- -----------------------------. Li •{!d Ca acit''. als Priv Distance.from nearest well ----_--_-___----____-.--- Distance from nearest building — Y: 9 ---.----------"_------------- ❑ Distance to nearest lot line----- --------------- -- Remodeling tt ------------------ ------------------------------- Remodeling and/or,repairing' (describe):------------�[ ---- -_ ___- -- ----------7----------- ---------- ------ - ------ h r --' --------------------------------------------------------------------------------------------------------------------1-r------------------;---------------"---------'-------------------------------------------_--------------- ! hereby certify'{hat I have prepared this application and thai'`the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations-of the San Joaquin Local Health District. �'' �- ontract [Signed}-------------- - ----------------'---- ----___�--------- ---_ ,. , „ a � . By:--------------------------------------- - ---- Title------ ------------------ (Plot plan, showing size of lot, location, system in relation to wells, 6uildings, etc., can be placed on rever side). FOR DOARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- ------------------ ---'------------ __ - -. : .." ATE_--• " REVIEWED BY ------- =---------- ----- DATE BUILDING PERMIT ISSUED-------------------- -_.__-_. _._. -- -- _. {� . DATE----- ------ Alterations and/or recommendations:---'-----=-------=---=---`------•---- - - �-••--------------------------•-----------------------=-_--...--•--•----•---•------•-------------------- - -- ------------------------------ -----------------------------•------------ ------------------------------------- -------------------------------•-----•---•---------•----------------- --------------------- ------------ ----------------- I ln�� ,. FINAL INSPECTION BY---------------- - -----------------------•----- Date -----=--------- --------•--- r SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mante_ce, California Tracy, California ES-4-2M , Revised ).57 F.P.CO. Via. .