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FOR CE FOR FFI ... . .......... Permit No. 4 .... ...... N PERMIT y APPLICATION �WSANITATIO ----- ---- (Complete in Duplicate) Date lowed .......... . ... ....... ................- This Permit Expires I Year From Date Issued ........t .........:.......- and install the work here-in described. Applitiation is hereby made to the San Joaquin Local Health District for a permit to construct I 'th County Ordin c No. 549. This 4pplication is m gr 0 iangth C IOND....... ..... JOB ADDRESS AN Phone................................... C 'ON' Z ........................................................ Owners.Name........... ............. 'Za ................................ ... Address_._...-......... . .... .. ... -------- Phone....................... .................................... Contractor's Name.------:..._.. .................... ..... ... ....... ..... 'I.st.1latian will serve: Residence Apartment House 0 Commercial [I Trailer Court EI motel 0 Other [I .. ........ .................... Number of,living units: .. . Number of bedrooms -c.?. Number of baths ../Lot size ----- Water Supply: Public system 0 Community system 0 Private [iceDepthto Water Table 1p d.. ft. Character of soil to a depth of 3 feet: Sand C] Gravel 0 Sandy Loam [I Clay Loam 0 Clay 0 Adobe ardpan 0 �e.;revrious Application Made: (if yes,date--- ................I No M�-<ew ❑Construction: Yes 0 No 0,�f�A/vA: Yes [3 No r 4 TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or cesspool permitted if public sewer is ................................ from foundation....................Material.......... e Ic n Distance from nearest well.................Distance i Liquid depth.......................--Capacity_........._......_.. mpartments--------------------------Size----------------- ----- --- N r a. of coline_.__...._..._. arest well.....................Distance fr6m foundation....................Distance.............Distance to nearest lot 5 a ' Distance from no trench._. .......... ...........Width of Number of lines.............................. ----Length of each line. length.____-._............._.................... Type of filter material-------------------/....Depth of filter material......._......i_....._Total in foundation. 0.........jistionce to nearest lot line.. Seepage,pp-.- Distance to nearest viell.-J'a.6.......Distant: f "I... Depth.... Number of pits...... ` Lining rr Diameter.. __Size: Cesspool: Distance from nearest well............ n....................Lining material................................... ...Distance from founclatio-----------------Liquid Capacity-......................gals. 0 Size: Diameter---------------..._..............Depth------------------------------- ------------------------------------ Privy: Distance from nearest well..................•_--•--.......................Distance from nearest building.. ........... ................................................... n Distance to nearest lot line.-.---•-----•--.......................................... Remodeling and/or repairing (describe):............................... .....................................................................I....................................................................... .......................................................... ................ ................................................. .................. ................................................................I........I............................................................ ......... ............--........ ............-------- ................................................................................... ............ ....................................------- in County I hereby c!,rfify that I have Prepared this application and4at the work will be done in accordance with San Joaquin let' f the Son Joaquin Local Health District, ordission s, end �Uloss and regulate CT te"i't 1 'Dwiter.and/or Contractor) 74144e,�.....V...........w....... ..... . . .... (Signed)..... Si -- ---- -------------- ................. BY.. ....--••---------- an reverse side). (Mat plan.*s-Kawitriq size of lot, location of A�sjr�tem 'in relation to 11 !ildings, etc.. can 69 placed A FOR DEPARTMENT USE ONLY cy 7 APPLICATIONACCEPTED BY../L/---- - ------------I-------------------------.._.-•-__-------------------------------- DATE. 7........ .......... DATE.......................................... REVIEWED BY..........................._....---•---........-----------... .........................................-:-------------- - DATE- ------- BUILDINGPERMIT ISSUED......................................-....--•----......... 4-7 ...................................... ...... Aherarlions and/or recommendations:...._..,..' ......................---------------------------- ....................................................................... .................._....----•.._._.............--------..--'...... . ................ .............................I.......-.................. ...............I............................................................ ....................................... ... ...............•.... ............ ................. ............................................1......................... ... ........... -------------------...................... ................................................................ -......................... .......................................t=----------..................................................L... -- ---------- ---------------- FINAL 'INSPECTION BY:/-14",r ..... Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 5Y.arn-ro Street 20S West 9th Street 130 South America-Street Led[,California Morisco,California Tract,California Stockton, colifornic, is 9 cv..c. 2. 9-41 AIL.11