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FOR OFFICE USE: I*� -4 ----------_------ ------------- ,APPLICATIONS -PERMIT Permit No. --------------- --- ------------------ ------- PO ICATIOM FOR SANITATION .... ------- ----------------- ------- (Complete in Duplicate) ---- --------------------------- -------------------- --- This Permit Expires 1 Year From Date Issued Date Issued ---- This application ib ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install fhL work herein described. is application is made in complianc-eiwifh County Ordinance .,574 1 1 4 Jj C� --------------- ----------------------_1-----------------------:---------------------------------------- OB ADDRESS A C�,T Owner's Name----•-- ... ------ ---------------------------------- ------- - ---------------'---.-'------ Phone---------- - --------------------- Address---------------------------- ---- ----------- - ------------ - --------------- ---------------- ---------------)-------------------- --- ---- 07 ------------------------------ ----- Phone Contractor's Name-----.-.- --------- .. ........ ----------- ------------- lg Installation will serve: 4 Residence Apartment House E] Commercial E] TrailerlCburt [3 'M el L] Other [I Jo 01, , Number of living units-. A---- Number of bedrooms__ Number of baths.--- -----tW size ---- --------------------- Water Supply: Public system Communify system El Private.E] Depth to Water Table ft. Character of soil to a depth of 3 fee . Sand 6,Gravel [] Sandy Loom E] Clay l E]. CI Ay ❑ Adobe Hardpan C] Previous Application Made: lif yes,clate- _qS'..40... No El New Construction: Yes E:1 NoX FHA/VA: Yes 0 No 0 TYPE OF INSTALLATION Al SPECIFICATIONS: (No septic tank or cesspool per M�'itted if public sewer-'ii-available within 200 feet;] I ank- Distance from nearest well------ ----------Distance from foundation--------j----1------Mate6al-----------------------------:-------------------- No. of co4arfme'r:)-fs_..-- ----------- ----�i?e--------------------------------Liquid �elth-----------ii---------- Capacity---------------------- i 4 or I — If Distance from nearest we? isfance from foundation---/---i0__r_____Dista9ce to nearest lot line-----5--------- *,N Sept 0 a''. n Number of lines---- ------ - --Length of each line-. .. I Width of french----- ----------------- 00 7--- X- Type.of,filf& me Depth of filter material_____Ig- -----Total!length ---------------------OZO--- ----------- Distance to nearest welik-A) -bisfance m f ndation____Z -'--.Distance to nearest lot line :5--------- Numb6r'of pits.._,�i----------------Liningmaferiallt�fg__.Size; Diar4et4r____3.3! ;'-_Depth----- ------------ cl"spool: Distance fi-orn-neatest-well--�- :-r_ Distance-from-foundation_:--___J------ Lining material______________r ----------------------- Size: Diameter----.--' -------1; -------- --------Depth----------------------------------------------------Liquid Capacity_-------------------------gals. Privy: l & (from nearest wel--------------------r--------------- --------- ---Distance from nearest building- -- ------- F1 ------------------I -------------------------- --- -- Distance fonearest lot line.------- - ----------------------------------------------------------------- Remodeling and/or repairing (descrye):---- ---- - ----------------------------------------------------- - ------ ------------- - --------------------- If--------------------------------------------------------------------------------I---- ---------------------------- - - ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------ ----------------------------------------- ------ ----------------------------------------------------------------------------------------------------- ---- .............. I here6y/60i, that I have prel6oa 4 ied this'applicatio'n-and fha4 the work wil.l,be done,'in,acc-ord'ance.with-San,Joaquin County f the San Joaquin Local Health District. ordinance a s, and rules and. regul ions s o AAA -- - -------- -------- -- ---------4 t ... ........ wrier and/or Contractor) (Signed)------ - ----- ------------------ ----- .... ---- ---------- -------- ------------- -- - - ----------------------------- ----- -- ------ -- ---------------------�(Tifle)------- ti:t4 ----------- ------------- By:------------------ ------- ize ---- .�Fiwn�"�of in relation to s uili4ings,-efc., can 6epI?'ce'd,'or�reverse side]' (Plot plan, showing s of lot, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ At"/--------- ----------------------------------------5--- DATE------1/ _ AZA------------ -- RE-VIEWED BY-------------------------------- ------------- ------------------- -------------------------------- I ------ DATE----- --------------------------------------------------- BUILDING PERMIT ISSUED--------- ----- ------------------------------------------------------------t..DA-TE..................__�_�--------------- --------------------------------------------- Alterations and/or recommendations ... ... j --------r�)---------157 --- i ------------------------- -- ----- -------- --- --------- -------- ------------ ------------------- qi ---------------- ---------------------- ---------- -- -------- -------------- ___14_76------ !��?-----_!1-----C?.......... --------- C'n ------------- --- :-, -------------------------------- ------- -------- --------------- --- -------- ------------ L -tr .. ---E�_� C,- FINAL INSPECTION BY------- ------- ---------------------------------------------------- Date--- ------------------ -- ---- -- -------- ---- ------------------------- SAN-JOAQUIN'LOCAL,HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West,Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1' VS 9 Rr6vlsEi3 a-59 3M 3-63 F%Pma.