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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit.No. ---------------------------------------------- -- ---- .... (Complete in Duplicate) Date Issued ...�A&. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....ltl-,Ivt� Owner's .,.... / � | Contractor's - " �� -�-__._--_.._~..__._-._.-- � -____-__---_--. in stallationwN serve: Residence [Z _Apartment House 0 Commercial El Trailer Court E] Motel E] Other E] ' � Number ofliving NOm6er of bedrooms ..A' Number of baths ..l.- Lot size -45 .................................... Water Supply: Public system [:] Community system [] Private CE Depth TO Water Table -------- ft. | Chiaracter of soil to m depth of 3 feet: Sand E] Gravel L] Sandy Loam L] Clay Loam [3 Clay Adobe C] Hardpan J3 Previous Application Am��wf|on Made: (if yax'date_-----') No JK] New Construction, Yes [] No 0FHA/VA. Yes �] No El ' ° ~ TYPE OF INSTALLATION AND NS- � d (No uepfic tnnk or cesspool permitted if public sewer isavailable within 200 feet.) . ' Tank- Distance from nearest well-----------------Distance from foundation....................Material .-'-_..--.._-_'---- [� Noof compaS l G 8 �D ' p ��,v | Field: ' ~ � C�� m ��m�1� ° -C�� to nearest � |��_ Number - � -' 'Lang+6 of each ||nm___..��f 7°......width ' ° Typo of - - Depth of filter mot=r'oL^kr~_' ]ota| ~'y^' Z-7~...........''--Seepage Pit Distance to nearest well '.A? , ".,.*"�w , foundation -/!!.^--------Distan�o to no*n*� |v* |��.- ��4 Number of u�s--.'�--._Un�g material 3�m: D�mete _ --_'Depth------- .»_�-_r-_^__- ~, ' : Distance from nearest well-----------------Distance from foundation-------------------- mofnriuL'-''----_'__.- V^ [] Size: Diameter--------------------------------------Depth------------------- _.'-----------------------Liquid Capacity..-------------------------- 8 Distance from nearest well '-'----_.._,.-^-^-.-D�tunce from nearest .____-_-._---.- ^�^ [] Distance to nearestlot |�o-_-_.---.------'____.______.______________.______ Rom�'o6oing and/or repairing (describe):------_.__-_--_-___-----..-��._-_�-_-__'---��'_.-___-_._---.---___--___--_-' , -'�------'-''----------�r--'------''-------'--'''--'--------'----'------'—'----'' --------------------------------------------------------- -' ----'---'--'---'----------'---'--'--''-----'--'------'-'-'---'-'-'- � \ Y hereby of | h*ve that the workwill be done � accordance with San Joaquin County ! ordinances. State |a°m. and ,ukmu *�6rpgulatimnn of the San Joaquin Local Hwu|+h District. `_g..~~/ ^~ . °~~°° t (Plot plan. showing size of lot, �femin elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY BUIU}|NGPERM|T ISSUED----------------------------------------.._--_''_-------------------------------------- DATE------------------------------------------------ -_-- and/or - -'''- - '------_- --- ' -_-'-_'__.''-__''---_-.''_ ........ ......'--' ~ ----------- . ....-.-Ft............................................................____ . _ ._� -.-.--_-- '` -------'__--'__-__--'----_-_--_.-_-----'------. --'--.-'--'-- '~. ~'.~~. '---'-'--''-_'_-'-_.''-''-'''-'''--'-'''--'-''--'_-''-----_'-' ----------- ........................, --------------------------------- --------- --------------- ----------------------------------------------------------- -------------- ------------------------------------ / - ~ F1 NAL INSPECTION BY:--'X��------------_' Date--�m-'��v�!_----------_--------- : / SAN JOAQUK4 LOCAL HEALTH DISTRICT N �n 130 South American Street 300 West Oak Street 924Sye°moro Street 205 West 9th Street � Stockton,California Lodi,California Manteca,California Tracy,California ' ES n ncv/mco a'59 uw 5'62 «/Lxn � ^ , ~