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APPLICATION FOR SANITATION PERMIT Permit No. --'- (Complete in Duplicate) Date |oue6-'\ 4, . Applical-ion is hereby 'made to the San Joaquin Local Health District forV permit to construct cl install the work herein described This application is made in compliance with Co f Or inance NoAS49J 0 � ' ~~'~' ^ '`~^~` �-1F Contractor's Name------------ --- --- -- ---- ------------- -------------------------------------------- - --------------------------- A_-z -------- Insfallaflon will serve: Residence House [3 Commercita r Number of living units: N b f bedrooms __7�umber of ba -7 Lot size .--------r ----------- Water Supply: Public system E3"eCommunify system [-] Private [] Depth,to.Water Tablejx_L_ ft. Character of soil to a depth of feet: S;�PNew Gravel ��] Su� L�m [j [] Previous Application Made: Ya, E] No Cons+ruction: Yes 0 No [] , � TYj%,_6F INSTALLATION AND SPECIFICATIONS: iseptic tank - cesspool permitted if pu6lic sewer is available within 20 ' � - Distance from.nearest.well'._''-''Distance from foundation-'''''''-Material '-'''- --'--.--'-- No. of compnrtmonts.-----.."..'-- ---- ize_'.-� ----------------------- Uqui6clep�6--------------------------Capacity.--._.-- ` Distance from nearest wek------------------Distance from foundation--------------------Distance to nearest lot line------:--_. Nu' 6or�o{ |inv,--.------.�-.Lenof of eutk Gn*,._-------VYi6f6 of �onch'_.--_--._.. J ' ` ' 'To+ | �mot .� '. � ---Total � _ x/�J=YX�� ��metu '^ Mumber *[ pO�.'��—�_''Uning '' uepm ' 1 - -- � : ' Distance from neon�two|L---'''� un6ufion--''-�� Lining motoriuL''-----.'.--'_-.-_ � . Size: D;omef c- .�.�/'/--..�---.�:De�t -----'-_�._��------Uquk] Capacity ---------gals. ^ . / Privy:~ D|dvno, fnom nearest well-------------------------------------------------Distance fnnm nearest Dibuilding------------------------------------------- �� -- ��nca�ton��re�t |o+ |in�-._--�-._----_—.__-_--___--_______.____.�___.___ � . ` / Remodeling and/or repairing �nv �ba)�'''.='-'-''�'�--�'�_-_-�--_--___'-_'''-_.___.'_-__�____________. ---------------------------------------------------------------------------------------�--.'�-�--_-'�_''__----'-'_----_''---_'__.---_------' ` ' _-'~� �--' ' --.-_--__�-____'-�.''-_-.__'-_-'-'�----' ` I K�� ,-f-_i- -j ----- --- ------ hereby erfif t t I have pre ed this ication and. at the work will be done in accordance with San Joaquin County uln V k ntrac"_ S. (Plot plan, showing size of lot, location of system in relafi t ells, buildi S, etc., can be raced on reverse side). FOR DEPARTMENT USE ONLY' �� ~ /\PPUCAT|O� ACCEPTED BY --------------.---_--'___-.. DATE---' --------- REVIEWED8Y'''--''-''--' ---- ------------- '------------------------------------------------------------- DATE_ DU|LD|NG PERMIT ISSUED. _-- �--------------.�------ ------------------------------------------- ------------ DATE V% Qj �Ahmro�nns and/or recommendations----_----`------_----_--_--.-_'_..___-'�_..--.:�----------------------------------------------- ` ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------- '-------------------------------- ----------------- ------------------------------------------------------------- ------- ---------------------------------------------------------------------------- ------------------------------------ --------- ---------------------------- ---------- '�--''-'''-'''—`''�'''-'^'-''-'-'-'''-'''_-'--.'''-'''�------------------------------------------------------------------------------------ � e- _ 7 � FINAL INSPECTION BY:------- Date-------------------------------------------------------------------------------- . . . � SAN JOAQU|N LOCAL HEALTH DISTRICT /oo so.* American Street 300 West Oak Street 132 Sycamore Street m* North ^c^ Street / Stockton, California Lodi, California Manteca, California rm"r. California . � ES-9-2M n°,a"d vv-2/00 -