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APPLICATION FOR SANITATION PERMIT Permit No --------------------------------------------------------- (Complete in Duplicate) Date Issued° '-� ' Issued -- ---- Application is hereby made to the Sun Joaquin Local Health District for o permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549. �� JOB ��ADDRESS � -� S AND U]C |�N � � -�� -^ -��--. -_----�" --------------------------------____ %.!_W_ __ -!--------------------------------------------------------------------I---------------------- ---------------------------- ................... / Installation will serve: Residence 0--'Apartment House 0 Commercial 0 Trailer Court El Motel [_1 Other [3 .............. k3 Number of living units: I---- Number of bedrooms j----- Number of baths ._1---- Lot size -----67ox-Lic-0............ Water Supply: Public system 2�community system [D Private E] Depth TO Water Tablew/49 ft. Character of soil to a depth of 3 fee+: Sand E] Gravel [] Sandy Loom [I Clay Loam 0 Clay F] Adobe Gff---Kvdpan 0 IZV Previous Application &4wdm; (If yes'6otm--------------------) No gr'--New Construction: Yes "A~~N-oE] FHA/VA. Yes E] No �| TYPE OF INSTALLATION AND SPECIFICATIONS: � (No wmofic tank mrcesspool permitted if public sewer is available within 200 feet.) Se T k ' Distance from nearest well-----------------Distance from found�f/�"--------------------Material ---------..................... No. of compartments--------------------------Size---------------------------...Liqui6 Jep+h---------Capacity.................. -- ~~ ' Distance from nearest wmU'r�.-Uistonco from foundoHon'I.O..'.^----------Distance to nearest lot line �~-......... Num6orof lines � Lengthof each line-----3-b-.�-.�__Y �th o{ �e « ~/ Tvpe of filter material.'...,--; -Doi of filter mote�uL-. � ......Total kwoth.. ........................ See Pit Distance to nearest we|_----------------Distance from foundation-------------------Distancufo nearest lot line___.-Num6a, ofpits----------------------Lining material----------------------- Diameter-----------------------Depth--_-_---- ' - Distance from neomsf well -''- ...Distance from foundation---------------------Lining material '_-'-'_-'-'-_-- � [] 3ba: Diameter-------------------------------------- --------------------------------- ------------------Liquid Capacity----------------------------gals. Privy- Distance from nou,mo well''''---''_''''--------Distance from nearest building.-_'-_-'---_-.---'' 171 Distance to nearest |o+ line----------------------------------------------------------. ..........--_--_----._____________ Romodel|ng and/or repairing ---_-_'___. ---._-__-_-_.__._--'- .�'.___- .___-----__.-_.'__--'_.-- -_--'_.__._---.—___-__-__-____--.-__._._-'__'--'_-'--'---__'_._..__--.__.'--'._--- '-----'-----------------------'---'-----'--------'--------'----''---'-------'-- be done in accordance with San Joaquin County ordinances, State laws, and rules and regul I s he San Joaquin Local Health District. It 04 s (Plot plan. showing size of let, loc; ion---,i--; ---e-m--in-re'l-ar-ion'-to_w`eIIs_,__bui1_din_g -c-a-n be placed on reverse side]. FOR DEPARTMENT USE ONLY REYIEWEDBY_--------------------------------------------------------------------------------------------------_----__--' DATE-_--_.___--__-__--- BU|LD|NE> PERMIT ISSUED-------------------------------------_--_-_.___------------------------------'--- DATE--'-'-----''---_-''--_.''' Alterafionwand/or recpmmen6atiom*:----------------------------------------------------------------------------------------------------------------------------.........----------------------- ---------------------------------------------------------------------------------------------------------------''-'''-----'--''--''--''---''-----'--'----'-' '-_'-'--_-----''---''---_-''_--'''-.----'''—___-'''---''''-_.'--'''-'--_''''''_----.-_.--'- . -------------------------------------- -------------------------------------'''—''' ------ ------ -------------------------------------------------------------------- -------------------------------- -------------------- ----------------- ---''''-'' ------------------------------------------_''-''''—'''— '_--''-' -'-'-'-_--''-' - � -l ' / ��_:_49. SAN �N/\L INSPECTION BY�-�/��---'k�! /\�� ---. Duto-..1./�--,�'�^m�'x�----------'--'� ` SAN NLOCALHEA�H �STR�T 2;� vwwSouth American Street vvnWest Oak ovre=, 124 Sycamore Street 2v5West 9,hStreet Stockton,California Lodi,California Manteca,California 7rcin'.C*nforn/a Es 9 nsw5sD n'sp zM o'uu ^ru^a