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--------- -- .Gt( . APPLICATION FOR SANITATION p • - --- -- - �--��_ '._ .. ........ -- --�. . Corn ER�lIT 4; ��xf��x -- This Permit ( plefe in Duplicafe) `- a 7rmit No. �;./s_r�_ •f. Application is hereb 1 x ires 7 Year From Date Issued This a a made to the San Joaquin Local Health District for Date Issuedapplication' is made in compliance with Count 1 JOB ADDRESS AND j v' my Ordinance No. 549. permit to construct and instali the work herein des A 'ION_- : described, _ /. Owners Name_. bed. ; Cf �� c : _L.r' z_ -- Address-Z, ------------ ------------- �« Z --------------- Contractor's G'.. ------------ - i ------- Name Phone._..... -�`'� ----- .•-- Installation will serve: - `� E _.2_�� ------------ Residence. ©'�parfinenf House of living --- ----- Number ---- ---- ---•-- -----------•---- �--- Phone--- T units: -- / ❑ Commercial �+✓�..-�l�l Water Su / Number of bedrooms -_. ' ❑ Trailer Court ❑ Motel Supply: Public system Number of baths -. ❑ Other ❑ Character of soil to a depth of 3❑feetommunity system Lot size --- �-� ❑ Private z ---- _ P Sand ❑Depth to Wafer Table W: C� ft -------------- Previous gppl;cation Made: ❑ Gravel � Sand f if Yes,clwe---- ,-- y Loam ❑ Clay Loam TYPE OF INSTALLATION --- ) No X ❑ Clay ❑ Adobe (No septic Tank or cesspool Sp�l p�CIFICA TIONS; New Construction: Yes Hardpan [� �' No ❑ FHA/VA: Yes ❑ No Septic Tank: publ;c sewer is available within 200 feet.) Distance from nearest wel1_10? No. of compartments-- ---.-D;stance from foundation-- C Disposal Fieid: _?� - - -- _Size_-/ -/---- ----._.Material - (,,� Distance from nearest well._ '�L'qurd depth,-..._ �e�t'z F Number of 1, ------ -----Distanco from foundation.. p ,t Ca acit Type of falter material-- _!: Length of each line___-_-- { ---- - ---Distance to nearest lot line_ ': Seepage it: �'' ... ,,' Distance to nearest w !� Depth of filter maferial..._. .W;dth of trench - of el!_-fC Ct` .�-fa Tata e --------------------- Number pits. -r ------Distance from foundation- 9t Cesspool: - Lining material__ G� •-- Distance to nearest lot line_---,5`C?•' ❑ Distance from nearest well. !._ ..`_ size: r- Diameter___- Size: . .............. Diameter._. '= ----- ----Depth. . .._.... Distance from faundaf;on_-. - p4`�-- ---_ Privy; --------- -- - -----------Depth_.-- ---------- - ....... Lining material-----. ❑ Distance from nearest well........... ... l Distance to nearest lot line-----.- L;quid Capacity__ --------------- -- ------Distance from nearest bu;ldin t Remodelinand/or re F x -------------- ------------------- 9q s. repairing d ) ^moi LZ� .. .� g escri --- ---- --- ..................l be - -- - F ----------- 1 -- 2ei Ze - - ----- ....... d --- ----- ----- -hereby certify +haf I have re --- - _ P pared this a _e.... ordinances, S+ate laws, and rules and r _ application and that the work Will be done in accordance w;th $ ' i ggula}ions of +he Sin Joa (Signed)_. L ,� �. qutn Local Health District. an Jo' B ------- ( t l L ''t ,, y [. quin County •_____-__•_-_------- {Plot plan, showin {i ^j / r Contractor) g size of lot, locaf;on of sysf mn�re t ` Ow er and o - LF . (Title]---- ells, .bu;!dings, efc., can be pla ed on reverse side]. F,`1PPLICATION ACCEPTED BY FOR DEPARTMENT USE ONLY 'EVIEWED BY ~— f . BUILDING PER M1ED - DATE --!cera}ions and/or recommendafions: DATE.._.... y 7—---- - ---- ---------------------- DATE ------------- .. ............... NAL INSPECTION BY:---- ----------- ...... ..... .- Date-_.1601 ---Z . SAN JOA PUiN LO F,karellon CAL HEALTH DISTRICT --- -- - Rva. ...... Stockton, Cplifornia 300 West Oak Street 1 Lodi,California 124 SYCQmore Slreet F.F'.0 o. Manteca,Calif,,,, 205 West 9th St,ve.