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y - ° . 47 � APPLICATION FOR SANITATION PERMIT Permit No. O ' ~~^r~ ~ in Duplicate) Date Issued '-^�� . ~ � Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compli�nce with County Ordinance No. 549, ' ' v�-� Con+�cfo/s N ----_-'---'_-''''-''_-''_-.''-_-'-'-''�— Phone _-'-_-'-- '_-'-' |m�U�� will serve: R�6�� Apo on+ H�� Commercial � Trailer C�� C� E] '--- Num6er of living units: Numberof bedrooms oms -n�/mumb� of baths�----I- Lot size '.�- - ��'�-�� ------- Water Supply: Public system [ Community system [ Pd"m^-)6 Depth to Water Tn6|o Character of soil toe depth of ua+; Sand EGravel ESandy Loam 0 ClayLoam ] Clay E] Adobe K Hardpan [ Previous Application Made: Yo, No New Construction: Yes FHA/VA. Yos NuEY. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank nr'cesspooi permitted R public sewer isavailable within 200 feet.) ` Sepfic Distance f,om`neu,n,t well----- --- ------Distance from foundation--------------------Material ------------------ No. of compo Liquid 6 h Capacity from td + nt �ex~DYspo,o| Field: Distance fmm | �� ~ __-. ^ --Num�vr of lines � Length of �u�� line Type of filter mot:,io\ Depth filter muterio|_~ � .---..Jo+u| length--�7�-_--.-.--.-. pe Pit: Distance to nearest well-�-�_--z-Distance from foundation--------------------Distance tp nearest lot line----- Numberof pU?'-'''--'''Lining material ''-'''''—Size: Diameter-----------------------Depth---------- --------''''-. Cexs000 : Distance from nearest well��--''Distance from foundation-------------- -----Lining ^ mv_+°--�oL--- --.—.—.-'- _ S�e � '-''-'-'-'—��-Do Liquid C_* - I\^r � gols. Privy: - -- - Distance from nearest waK.-----_—__----'Distance from nnores building---_--__.---.- [� Dis+000n to nearest ]of [n; °--------------------------------------_' - ' � �° �_-'-_ '-''_.________ Ramo6�ing and'/or repairing (6��b��'-' _________ ------'---- -----'r---''----'--'-------'--_'-'~----'--'---'' --'- —'— ----------- _ T� �`'��'��`�� —��'��'��'��'��'-��`��``��-```�`��'��'��`��'� ----------------------------------------------------------- ___._______________________._______.__________________-�--'__--_—. &� hereby certify that I have ^ +hat the work,will be done in accordance with San Joaquin County .� ordinances, State laws, and rules and regulations of the San".joaquin Local Health District. p`gnmm '-'--------------------^~~'~` ~'~/~ Contractor) ' " -_.'-'----'---'.'---'--'-_.--�---'''-,, .i+.-,_-''-'�---_�--_'-��-'_-`''' ' (Plot pLu, . showing size of lot location of system in relation to wells, 6uUdings, etc., can 6e placed on reverse side). ' FOR DEPARTMENT USE ONLY . � APPLICATION ACCEPTED �1 _+ DATE------------------ DATE .. __ _ - ' ------------'— ------�---'---' -- '' '�r''------� ' REVIEWED . D�TE'.— ��-��'�-___—. ' --------------- BUILDING PERMIT ISSUED------------------------------------- DATE'.--��_._--.--..-----.-------' Altonationownd/or -^.---- - -.-----------'---_-_------'----.'---'--_'---._-_-_--.— ____________________'______________________�____________'_________________________________'____ ..........-----------------'_-__.-_.'--!'''-_''�''---_-'.--''---''---''--''---''---'------'--''--'---------'--- ��_��'��-�'----�-------------------------------------'�-------------------------------------------- ---------------------------------------------------------'----------------- _____��__________' | ___________.__________�______________________ ' ' �� _ / x�� �N/\L INSPECTION BY: -�_��~��''m�~*��-��. Da+e--.��.��-'-�.j��--.__------ / ` � SANJOAQU|NLOCAL HEALTH DISTRICT mn s""+h American $,=» 30D West Oak Street mx Sycamore Street m^ w"*h ^C^ Street Stockton, California Lodi, California w"mm=°, California n""y. California