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. � �~� SANITFOR OFFICE USE: <br /> ATION/ APPLICATION nwR ��� A[ION PERMIT Permit No. <br /> N - <br /> - A(-------------------- <br /> ~ � O*�c�� <br /> (Complete— Duplicate) Du+o Issued l�����......- <br /> Application <br /> hereby mm6o to the San Joaquin Local Health District for u permit to construct and install the work herein described. <br /> This application ismade in compliance with County Ordinance No. 549. <br /> J{}8 ADDRESS AND LO 4",34-1 ------------ -_----_---------.----.------.-----------.. <br /> OName" <br /> �c �r ~�� � --------------------- Phone----- -_-.---.----. <br /> r' �------- <br /> Contractor's Name--------- --------'��--..-------.-----_------------------- --------------------- .--------- Phone---------......-.--_--- <br /> |msta|lationwill serve: Residence Er""Apartment House [-] Commercial F] Trailer Court 0 Motel [_1 Other L] <br /> Number of living units: _/-. Number o{ bedrooms A-' Number of 6mH`, Y—.. Lot size Z�'.'- ' .------'_----- <br /> Water Supply. Public systemmmundY system [] Private [� Dnp� +nVVmterTu6� �&,. ft <br /> Character of soil to depth of feet- 3un6 [] Gravel [] Sandy Loom E] Clay Loom 11 Clay [] Ado6e0~-11Hu,dpon [] <br /> Previous App||cmf7*m Made: (If voo'6ote-------- ----------- No e Now Construction-. Yo, 91^~No D FHA/VA. Yes [] No <br /> TYPE C>FINSTALLATION AND SPECIFICATIONS: <br /> (N* septic tank or cesspool permitted 7fpublic sewer isavailable within 20¢ feet) <br /> Se nk' Distance from neune,two|| '---- �l�tnnca from fovn6o6on�� ' �u+ i- <br /> p"�,p' ' -----.. ----- �no/-.`�z�x�`r��z- <br /> p� No. �fcompur+m�n+,-��-----..Size.-������.��-._-�quid dopfh-'��------Capacity _ ~ <br /> Di, Fi�|6� Distance from nearest well------- Distance from fou"�ut� ./ <br /> n. e.---..Distance to nearest lot |ine'��..-- <br /> n�^ Number of lines_.-(— Length of each |ino-��.-'.-._.—VV|dtk -Z ^ <br /> Type of filter maferial.___tIe�_A------Depth of filter --_-'Tota| length <br /> ..'��.._--_---__ <br /> Pit: Distance +o �e| ''/�'' '-_D�+on�v +o nvuroo �� kno'�~ -- <br /> � ' Num�or of p��-'y---'-Lininq ........... <br /> ~ ' <br /> mot�'iu(-/�°^ ��--J�e� [�om � --�D�pt -.��-�,--_-- <br /> Ce, poo: Distance from nearest well--------- -------Distance from foundation------------ ------Lining mute6aL--'-�---''-''- <br /> ID Size: Diameter --- -------------------------Depth--------------------------------- ------------------Liquid Capacity.-------- ----------------gals.Privy: Distance Disf ncefnom nearest well-------------------- ---------------------------Distance from nearest building--------- -_''-'__.—'-- <br /> [] Distance to nearest �o+ line--------------- __----_----___-_____----__---'---_'—'� »� <br /> Remodeingand/or repairing o\:--'''--''—'''- ---------------------------------------- -------- '-''-''_----------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------_-.---_-_--_--__-_-__----_.----.-_-___- <br /> ---'-----'-'''—'''-------'''-'----'---''''-''--''---'--'-------''---'---'—'--''------'--- <br /> .-'---_--'----'''-''---'__.'---_-''-----_'''--._-_-'-----'-__'---~----''_-_''--''-�'-'--'-_ <br /> | hereby certify that I have prepared this applicalion and that the work will be done in accordance with San Joaquin Ccunf,, ^- <br /> ordinances, State laws-, and rules'i�nd.r_egulatr'LonZs'of e Sa Joaquin cal Health District. <br /> (Plot plan, showing size of lot. location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FORDGPARTMENTUSEONLT <br /> 01 <br /> APPLICATION ACCEPTED 8Y.---.—.- -------------- --_--._- ------ DATE'-.� <br /> ------ <br /> REVIEWED BY Q\-'_--''--'''---'-'--''����--- ----------------------------- DATE---------------------------------------- <br /> --_--'- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- -------------------------------- DATE-_------.—.-_----_-- � <br /> Alterations and/or <br /> -''''--' ''-_-'-_.--_-''---''--'''-''--_-_-' ­ <br /> ------------. = .~---__^-..�°.—. -)�-��.-_-._'_-_.-_-_--.. <br /> ---�i�����-]���--. - _0------ ---- <br /> -------------- -------------- ------------- <br /> -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ---------------------- --- ------------------------ . . <br /> --'--''-'-'''----�'-�''-'''-'''---'''--'''-'''--'--'''--'''-'-''--''''-''-'''----'-'-''''-- | <br /> �� <br /> FINAL INSPECTION BY: ------ ..- --------------------.. Date--- --- ---- - --------- ----_-. <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> 16o1s.x"xe/*"Ave. 300'w+st Oak Street 12^Sycamore Street zo,West 9th Street ' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> "° 9REVISED B'°~ 3M 3-'63F.P.*". <br />