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FOR OFFICE USE- ----------------- SE::: - - --- --------- --------- ---- ------ Permit No. APPLICATION FOR SANITATION PERMIT i1 ----_._ (Complete in Duplicate) Date Issued II " -�+- This Permit Expires 1 Year From Date Issue - - _ , I Health Dist for a permit to construct and install the work herein described. Application is.hereby made to`the San Joaquin Loca This'applicatiori is made in compliance with County Ordinance No. 549. 1 i JOIiRADDRESS D OC - it ------------------------------------ OW -------- Phone .E �i ners Name - ------ is ----•---- ---• - �3 .. . Phone -----•--dress s Name__. y t 1* -------- .AdContractor R I Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer r Motel ❑ Other ❑ !! r Number baths --/-- Lot size ------ Number of living units __�__ Number of bedrooms ____ ___ Water Supply: Public system;`❑� Community system F❑ Private Depth to Water Table . ft. i of 3 felt: Sand Gravel`❑ Sandy Loam ❑ Clay Loam �y ❑ Adobe ❑ Hardpan ❑ 'Character of soil to a depth ❑ o. t FHA/VA: Yes ❑ No ; Previous Application Made_ (1f yes;date____________________) No New Construction: Yes No ❑ .rRTI(PE OF INSTALLATION AND SPECIFICATIONS: ' . (No septic tank or ces"spool permitted �if.pu6hc:sewer is available within 200 feet.) .;, . . __;Dista cf from fof dation_- 1©--------Mate�aL__________________ p from nearest wel4; j Se tic nk: Distanced ff Capacity- r, No. of c Impartments=:__ ; .�"" _ _`+Size_ _fv-- -� •, Liquid de�th___"f¢---.____ -- field: Qistance- --- ------ - --- pisl� from.nearest well..^-�d...-:'Dis#ance from foundation___ +1 -.-------.Distance to nearest to{line_______._ �D4.pOs : _�___ ______-Width of trench_. �: Number.of`#Ines--------f - LeMgth of each line--- ---- 11 Z ';1 �e th of filter material_ -_� _ Tota! length___.___ _I--�--------------"--- y Type of filler_material_ _p f _ F -, __.._..__.Distance to nearest lot fine__._ r ,Seepa Pit: Qistance#;to nearest twell______�_t p..__{__C�istante from f undation_._ Number of #s.__._ _Linin material_ L.�--Size: Diameter------- ----Depth-----� J------------ .: !'I p . g � .-� �C�sspool: : r Distance from nearest weil_________,-____Distance from foundation_-..__._..____.__.Lifiin�ateria!-----------------------------�"-als. ❑ Liquid Capacity--------------------------- t Size: Diameter-----•------------------------------- Distance ----------------------- Dep#h g Pr!vy: Distance'from nearest well----____-- "---------------- Distance from nearest building-------------------------------------- -- P ---------------------------------------------------------------- rivy. to nearest lot line--------- -------- ------------------- El I Remodeling and/or repairing (describe):----------------------------- - --------------------------------------------------------- -•-------•----------------------- 4.II --------------- ------------ ----------------- ----------------------------- - ------------ ----------------------- -------- --------------------- �.' --- ------------------------------- II`it i -- . If that I have prepar this application and +h I hereby at the work will be done in accordance with San Joaquin County oVdinances. State w and rules and gulattons,of a Sa Joaquin Local KlOth 'Distric%, a t - -- -- --- � ---- - ------- ---- --- ---------- --------- --- r Contract {Signed}------ ---- -- --- --- ------------ - --------------------------- - - _ _ �� (Tale - - -- -- ]ls, _ __ l f system in re(Plot plan, showirig siie of-lot,location oa+ion to w I ;buildings, �e placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDI BY --------------- DATE__ ` 'p` ------------------------------ DATE REVIEWED BY--------------------------------------------- ------------ --------------------- --------------------------- DATE BUILDING PERMIT ISSUED--__-_- ------ Alterations and/or recommendations----------------------- -----------------------------•------- --------- -- -- -- ---------•--------------------•-----------•--- Il _= _ ------------ ---- G - �.3 . = - ------------------- I`iI!7pj FINAL INSPECTION�Y4�� ------------------- - -------------- - - ---- li � Il SADV'JOAQUIN LOCAL HEALTH DISTRI T I� I' 124 5 camore Street 205 West 9th Street 14Q1 E.Naselton{�1Ve.. 300 weal Oak Street y , I Lodi,California Manteca,California Tracy,California Stockton,California ! Es 9 REvisro a-s9 — 3-'63 F.P.CO.