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��r•�. �� Permit No. -• . LOCATION FOR NITATION PERMIT r� G� APP > Date Issued -.��-�•-- �� [Complete in Duplicate) Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San pp ith County Ordinance,No.. This a lication �s made in compliance w I OB ADDRESS AND OCATION------ - -- � ---- ---- -- -----� Phone_ -��--� •-•--------------- (� _ ----- -- °---`� '-- J__ Owner's Name----------- _. =rr - ------•--------------------•-------•-------- �/� Phone_ Address.---•-•-------- ---------1-- -:f --- -------- ------------------------- Other ❑ ___ Motel [❑ - - --- -•-------•------------•---------•-------•----- --- ---- --- -� Trailer Court ❑ Contractor' Installation will serve Residence i, Commercial ❑ ' Apartment House ❑ - ----------- ----- -#Number of bedrooms _-��,- Number of baths __ _-- of size -_- .- Number of living units: -------- y Private ❑ Depth to Water Table .-----• ft Hardpan ❑ Supply. Public'system �Communit Sy stem ❑ Loam Clay Loam ❑ Clay ❑ Adobe [� WaterI Gravel ❑ Sandy L ❑ �,� FHA/VA: Yes ❑ NO 1 Character of soil to a depth of,3 feet No and.❑ ew Construction: Yes �o ❑ Previous Application Made: Yes ❑ i T TYPE OF INSTALLATION AND SPECIFICATIO ublic sewer is available within 200 feet.) _T .� nk or'cesspool permitted-if'p ------- .,. [No septic ta ------- FITCa acit ---- S tic Tan 'Distance from nearest well_-____-------._-Dizea��e_fro ;oundatioL qU�'a--depth_Materia•-------------- -- No. of compartments_ - .Distance from foundation--------------------Distance ----- -- ---------Distance to nearest lot sne---------•--•--•- Disposal Fi Distance from mearest well- Number of lines-----------------eweLength of each line - ----.Width of trent Depth of filter material----------------------Total length------------- - Type of filter fmafarial=------ ----------- p , I istan,ce to nearest lot Distance from foundation----3_-Q V" " )-. -Depth_ Q--------------------- Seepage Pit: Distance to nearest well._ 1 -g Size: Diameter._.--` . p Number of pits- ----- -------------Lining material__ Linin material -gals, G ------------- Qistance from nearest well -----------Distance from foundation__-_-_�-------- �---� Cesspool: --_____-__Liquid Capacity C ❑ 5ize: Diametir --------- ------------Death----------•------'------- ---- Distance from nearest building------------------------ L1 from nearest well Distance to nearest lot line-__._------- I r 1� J�^ Remodeling and/or repairing (describe]: ------•-- ------------- -- ---------------------------- Ia 1. -------- I-------------•- - __._.----------------------------------- ----------•---------------------- - - •------------- (-----•------ -- ------------- --- ---- - I havi----------------------------------- ----- l l hereby certify thata prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinance ate laws, and rules and regulations of the San Joaquin Local Health District. 11 _-[Owner and/or Contractors -------------------------------------------------- --------------------------------------- ------- - - -------- Y a----------------------------- (Signe [Titl e�. BY-' .... to plan, showing size lot, vacation of system in relation to wells.'buildings, etc., can be place on revere � [ FOR DEPARTMENT USE ONLY 4- -- DATE---------- ------------------ PATE--- -- APPLICATION ACCEPTED BY-•- ---- -- ----------- ------------------------------- �. REVIEWED BY_._'----------------------'--------- - ----------------------- DATE--------- -- ------- ------------- ¢. BUILDING PER ISSUED.____.---_ -- ---- Alterations and/or ret mme dat'on .. --- •------- •s k ------------- ---------- -- , !s -- Soy-, . ----- 4•�7 .�t ' ` . ----- - ,._ ----------------------- FINAL INSPECTION BY:_-'--- . /j SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" C Sfreet Sycamore Street ;00 West Oak Street 132 SyTracy, California 130 South American Street Lodi, California Manteca, California Stockton, California ES-9-2M . Revisea ).57 F.P,CO.