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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._z� 3---- .......................... -_....................... (Complete in Duplicate] ........ This Permit Expires 1 Year From Date Issued Data Issued is hereby made to the San Joaquin Local Health District for a per -nit to con fruct and install the work herein described. This application is made in compliance ith County Ordinance No. 549. I ''I I , , t jO3 ADDRESS AND LOCATION y " A - Owner's Name ......... Phone ...__ ................ ji Z.IiwA- Address- 2 ............... ............ ............... ............. L Coniractor's Phone._....._........ . ... .... Insf4IIa+ion will serve: Residence Le Apartment House I-] Commercial C] Trailer Court 0 Motei [I Other [I Number of living units., Number of bedrooms. -3., Number of baths _,_ Lot size Water Supply. Public system C] Community system F] Private f -j! x Depth to Water Table ___ fir, Character of soil to a depth of 3 foot: Sand [] Gravel r -I Sandy Loam 211"Clay Loam [3 Clay 0 Aclobt C] Hardpan F1 Previous Application Made: ilf ves,dote No M New Construction. Yes [j No E], FHA/VA. Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) se 0;stanc'- from nearost well_ .Sle Distance from foundalion_.!A.. ...... '.material No. oll" compartments-, V Dispose_V1k ield: Distance from arest well...447JIDistance from foundat;on.._-'L? . Distance to nearelf lot Ungth of each ....... 'Width o+ Nurnber of lines... I Type of filter of filter material Total -------- so-I, Distance to nehrest wall .....ZWJ Distance from, fciundation.;.J.4._......Dstance to nearest lot line_$ ......... El Number of Difs ._-�,Lining_ 'Material.., Cesspool: 01stanco -i�-om nearest wall........... _.L.Distance from foundation Lining material ............ ...... .. r". - - *� -1.- Fi Size: Diameter ........Liquid Capacity ... ....... . ............... gais. ....... ! --E- ... -- Privy; <441)ioance from n , ar t o es .......... ...... from nearest building- ............. ..... DisfanEe io,neorastjot ....... ........_.._.«,.............._.....................w......... Remodeling awAi,lep .... .. 4, 2 ............................ ....... .................. . ... ......... .............. .............. ------ . .. . ......... .... . . ......... . .......... . ........ -1 ...... ........... i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County State I and rules and regulations of the San Joaquin Local Health District. ........ ......_.......u.. Contractor) . . . . . . . . .... (Plot-plari, showing size o4 -10t, location of sysia in relation fells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED By... ...... �. ...................._.........,....»..._................._..K DATE -J ............ REVIEWEDBY .......... .. ...... ____ ....... . ..... ...... ............. ....... DATE__......._.....,-,..,...._....... —BUILDING PERMIT ISSUED.-.. .............. ........................ - ................ ____ ......... ........ ____ ... DATE..__...._,......__. .. _ ..._....... - ...... . ........ �.Iferafions and/or recommendations-,.....-......_ ......... ...... __ ... __ ........ ............... . . . ................ . ......... ............ _ I.- ................ ......... ...... ....... ............. .......... __ ...... . .......... ....... ....... ____ ......... ........ ...... ......... .. . ...... ....... .................... FINAL INSPECTION ........ ............. Date _/ ...... I ... . .. . ......... . ...... ...... ...... SAN JOAQUIN LOCAL HEALTH DISTRICT Hax*1f*n Ave, UO Woo Oak Street 124 Sycamore Street 205 Woo 9th Street Stockton, califetrito Lodi, California Mant*to, California Trocy, California CIS 5 *CV11-co 0-1*) 3M 3-163 F%P,cc.