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t / Permit No ( r AP LICATION FOR..SANITATION PERMIT (CompleiYe�in•Duplicate) Date Issued ---y S_ G---- This Permit Expires I Year From Date Issued :1 \ tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application y This application is made in compliance with County Ordinance No. 549. � i549. � - -------II' -------- JOB ADDRESS AND LOCATION--- - -- l � =/ Owner s Name--------- --- ----- - --- - Phone_. -- -----------------•----------- 1 /�-------- } -------------------------------------- Address_ ----- 1Phone Contractor`s Name-----j Installation will serve: 1. esidence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ , ' 4 ._-�i --------------------------- Number of living units: _-_.___- Number ofl bedrooms _ Number of baths --______ Lotsize I! _ Water Supply: Public„system Comf4o,ity.. system ❑ Private ❑ Depth to Water T ble -------- ft. I Character of soil to a depth of 3 feet: Sand El .Gravel [ISandy Loam ❑ Clay Loam [IClay ❑ Adobe� Hardpan ❑ V tN Eli- Previous Application Made: Yes ElNo New Construction: Yes E] No E] FHA A: Yes ❑ TYPE OF INSTALLATION-ANB•-bPEGIFIC`� New (No septic tank or cesspool permitted if public sewer is available within 200 feet.),- Septic eet),- �I Se tic Tank: Distance from nearest well-----------------Distance from foundation- -- a eri ___.._______---__..___..__--______.___._.--____. -------------- --- p -- y----------------------- ------ qf� Di p`cit ❑ No. of compartments _ --- Size--.------_--"-- - Li uid de t :-_"--:-"-""-- - a from p s '_ -P'- --- --Width of trench. - net?•_` Disposal Field: plurtnberof ILnesearest well.. Length ofeachI ne Z� , ”" stance to neir. " Total length----2 "" - Type 6f`filterate al;_ �-e4.•"-� :Depth of filter material_._/ -------. ----------------- -------- ` ` i�taac� tt �aresf lot line--- Se e Pit: Distance to ne�•e Lx ,t"'� --Distance fro ----------- foundation- - _ ,A Size: Diame er' ` ........... D pfh,�� Numbe of✓�ifs"�:*- ------ -----Lining material ' Distance from foundation______________ ____Lining materi I-_._---------------------------- N u Distance from nearest we! --_- """Li uid Ca act I gals. ----De th--------------- --------------------f q P y... ❑ Size: Diameter------- --- p __._Distance from nearest building__ -----_ __________________1- -------. Q Privy: Disotanee-from-Pearest II------ - ------------------------ - 2 II ❑ Di ante to nearest lot Iiie-----___ ----------------- li �T i Remodeling and/or r airing [describe)------- -------- ------- - -----------------------"---------------------------•----"-----"--------------------- �` ----- - ---- yp p J urn Local Health Distnctn Ian Joaquin County f I hereby certifythat ave re ecthis application an that the work will be done�n-ec�cvsden h S } ordinances, State laws, and rules-a regulations of the San o O er a /PZ.--,� - -------- r Contractado orSi " ( ---------------- Title --------------' ' By:- -------------------------•------------•----- --- - -- ---------- ------------ ------------- ---------- - (Title)P l (Plot plan, showing size of lot, location of system in relation to wells, bu dings, etc., can be laced:on re se 'side}. I FOR DEPARTMENT, USE ---- --- i APPLICATION ACCEPTED BY____________ ___t � DA`�E__a�_ r-- ---G--�------ ' :. II !T ISSUED - - : w A•-AEE ---------.-----1 - -- - -- -------------------- I r REVIEWED BY- ---------- ----------- ---------- ------------------------------------------ - BUILDING PERM I Alterations and/or recomm dations: - ------ - ------- --------Q` �� ----- _©�_---�-F ------1iH---------,--U-- ----------- 1"r !7 c, ----------------------------- ------ - ----------------- -- ----------------A--- -- 1 -17------aF------�� t 171._R7T - -------------------------------------------- --m-IX. IN !T 4Rv" FINAL INSPECTIO Date-------------- ---� `-�-�------��---- ----- ---- -- - ------• � --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT j 300 West Oak Street 132 Sycamore Street 814 North"C 130 South American Street Trac Ca Stockton, California Lodi, California Manteca, California Y { ES-9-2M Revised 8-'59 F.P.CO.