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_ I 0 "? Permit No. APPLICATION FOR SANITATION PERMIT"' / (Complete in Duplicate) Date Issued _,_� ------- 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f This application is made in compliance with County Ordina e No. 549 _ JOB ADDRESS AND LOC 'i. Phone--� ------------ --- ----------- Owner's Name-------------------- - ------ ------� �� e .---- Address.---"-----------------•---- Phone _ 7 Contractors Name-------••--- --••-- ••-• -------------- --------------- - - I Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ / Y Num;;D,Fth aths _/--- Lot size .-""" --_- -- Number of living units; [_."- Number of bedrooms -" " ii Private to Water Taft. Water Supply: Public system [] Community system ❑ .r Character of soil to a depth of 3 feet: Sand Gravel El .Sandy Loam ❑ Clay Loam [I Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No1.❑New Construction: Yes No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) p is Ta Distance from nearest well""_""" __-_"""Distance from foundation--------------------Material----.-_--.--------.- ---- No. ofcompartments- Size Liqu00i j Capacity i --- ---- --- ---- il. �f # ----.Distance to nearest lot Ike__. Distance from nearest wel!"�`__ . Dis#ante from foundation- sspasa t i q ` / Width of trench- "~ .----- ---------- Number of lines-_-/-- Length of each lin ----- Total length 's A Type of filter material r Depth of filter material---.IS ------P - -. �j Seepage it: Distant e to nearest well""- Distant om foundation--_--__ 011-'--.D•st nce to nearest I'll lin{e"--�.---__"--"_ Size: Diameter--- Depth --•---• p -----------------Linin matt ia,� I"�-- Number of its-_.,� g Cesspool: Distance from nearest well---------------- Distance from foundation-------------- --- nngtsial ---- ----------- ----------gals Size: Diame#er----------------------------------- -Depth---------------------=------------------------- ---Liquid Capcaty-------------------=--------• ❑ . Privy: Distance from nearest well-------------------------- ------Distance from nearest building---------------------------------------- 'V Distance to nearest lot line"-------------------- ------ --------- ---- -•--"--- ---------- El Remodeling and/or repairing (describe)--- -----------=--------------------------------- il ----------------------------------------------- - ----------------- I ------------------------------------------ --------------------- --------------- ------------•--------------.._----------------------- t. ---------------•------------------------------------ ------------------------ -- -------------------- --------------------- -------------------------- -------- I hereb certify fha I have prepared t ' Iia that and that the work will be done in accordance with San Soaqun County a ordinances, ate laws, a d rules and reg iati.insppo�f +he \)a Joaquin Local Health District. 1 ont raptor i (Signed) -- ---------- - (Title---•-- �'-- -- - sY (Plot plan, sho g size of lot, location of system in.relation fo wells, buildings, etc., can be placed on reverse jSi; e�. FOR DEPARTMENT USE ONLY f DATE----------------� j�---------------------------------- APPLICATION ACCEPTED BY DATE------ -- ---------- =--------------------------- REVIEWEDBY-------------=--------------------------- --- - )ATE--------\r -----------------------•--------•-:. BUILDING PERMIT ISSUED_---------'------------------ - - ----------- -- Alterations and/or recommendstions: - �_S 1� ""-/I le: ----------------------------- ------------------- `''t�G -----, L. fJ -. 7 � ---•- ------------------------- ----------------- ---------------- _7--------�J� s "".0 =qtr-- "a5�4.r� y JQr C.r� rC ,%s- --41111y---- - -------------------------------------- h ------- • Date--:-- FINAL INSPECTION+BY:------ -------------------------------------- --- -- �' = /SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oelc Street 132 Sycamore Street 914 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y� ES-4-2M Regis., 1.57 F.P.CO.