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�} 0\1I A_ F`0ATION FOR SANITATION PERIv, _ Permit No. zd �Y • (Complete in Duplicate) ��j�•/ 1 1 Date Issued .._._..__..._..�� 1 Application 1s 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. S JOB ADDRESS AN „ OCATIONf------- --- - - - " - O ner's.Name.. _ Phone. ( ~ A dress.._..•2.. ----------------- -------- -- kontractor' am_e- -i-----------' - --- ----------------....-......--------------------'... Phone_ ..- T2� -' ------ Installation •Il serve: ! Residences Apartment House ❑ Commercial ❑ Trailer C urt ❑ Motel Other ❑ Number of living units: .../ Number of bedrooms �_O.. Number of baths .�.._. Lot;size;--- 2Co2 -------------------- Water Supply: Public) systemJ� Community system El private ❑ e,.Depth to Wafer tablft. Character of soil to a depth f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loary ❑; Clay ❑ AdobaO Hardpan ❑ `) Previous Application Made: Yes ❑ Nog New Construction: Yes,9 No ❑ FHA'/VA: Yes-b NOPO TYPE ORNSTALLATION AND SPECIFICATIONS: ptie T nk: P NoDistance tomo nearest well..P. __.__,_.--Distance from foundation depth .................... No septic tank or cesspool ermlt+ed if public sewer is available within 200 feet. p -Capacity.........--'-......- Disposal eld: Distance from nearest..well-.__..---.......Distance from..foundation._.--.-.___-----Distance to nearest lot line................. Number of lines...................................Length of each line------------------------------Width oftrenyh--------------------.. ----_____ Type of filter material.........................Depth of filter material... ..Total length_..._._._._.__....___...______..._ Seepa a Pit: Distance to nearest well- [... ..---Distance from undatio ..Distance torpearest lot line 1\ r_�'74: Depth-_ - C sspool: Distance fromnearestwell--Linin --DPance from foundation-.:------ .__Lining material_..._._..__..._..___..______--- Number of P � 9 ❑ Size: Diameter--------------------------------------De th)\,,: T---Liquid Capacity.----------------------_--gals, Privy: Distance from nearest well-----------------------------.-----------.-------Distance from (nearest building ❑ Distance to nearest lot line -------------'-----.....---" �T._. . -----f __------------------------- Remo d/or repairing (describe):___ ------------------_ ---- .--------.------------__._ ....__- _. ...... -_-----' ..........-----------------------------__......... .. 7 I hereby certify that I have prepared this application io that the work will be done in accordanl�h San Joaquin County ordinances, a law , nd rul an egulation f the Joe in Local Health District (Signed).... - -- - - --- - - -- l .0 ..__ ._-,------- r— ---------_-------- --- -----(0 . d/or actor) r Conti BY --------- ----'- ` �� ---- - - r- -------------------------....(r+�P ` /F side).= ..... - - (Plot plan, showin size of t, location stem in a afion to wells, buildings, efc., can be I ced on ve ErOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------' ...... __ DATE--------------------------:-------------:------------- REVIEWED BY-------------------------------------------- - ... -- -- - - ---------------- DATE.----- - -------------- - BUILDING PERMIT ISSUED......_._..__.._..___.__...._. .. DATE--------- ------------- Alterations and/or recommendations:----..... ....... -. --------- -- ------ �If - - - -------------------------------------- ..... -_--------------- - ---------'- .�'-------- - - --- -- . ------ - -.. - - - - - ---- --....Z - FINAL INSPECTION BY:.-...... rye. " - -- --- J Date`----��. 1-- ---------- --- ------------------= r SAN JOAQUIN LOCAL/HEALTH DISTRICT ry 130 Soufh American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" Street Stockton, California Lodi, California Manteca, California - Tracy, California