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FOR OFFICE USE- -------------------=--------------- - --- ---- APPLICATION FOR SANITATION PERMIT Permit No..P.�� -----------T- -------- --------------------------- ------------ - -- ---- ----------------- (Complete in Duplicate) Date Issued - ------------- ------ This Permit Expires 1 Year From Date Issued ------------ --- Application is hereby made to the San Joaquin Local Health District for a permit to construct dxinsfall the work herein described. This application is ma-de in.y"0 Bance' ,;/itK County OrdinancenCe m No,1549. fOT 4.. 50 JOB ADDRESS AND LOCXTION..............7YO--------CAMBEAD4-E------" ) M------------!------/__alti s --------------------- !-A... Phone---------- ------------------------- Owner's Name--------L-PH-14-0-Ps------CON-5-T-Rum-0----- ------- II I -------------------------------------------- --------------------k--=-------------------t '61 f------------------------------------------------------------------------- Address-------------263-2--A 2-P-0.1.2-ma, ------ Contractor's Name------F77U --------------------------------------------------------------------------------7___ -------------------- --I . Phone.. 'fel [3 Other Installation will serve: Residence [K Apartment House El Commercial E] Trailer Court El ' Mc ❑ Number of living units! Number of Sedrooms -3--- Number of baths L8t size ---------------------------- Water Supply: P61oiic syst;m p,`Community S stem El Private El Depth to W6ter' Table ja¢f t. Character of soil to a dep1h 'of 3 feet: -Sand Gravel El Sandy Loll 2( Cl ay: Loam ay ❑ Adobe E] Hardpan [I 1 1El, 1 on:'Yes No E]. FHA/VA: Yes No E] Previous Application Madef jIf y6s,date--------- ......_ New Consfructi1 No Z' L TYPE TION�AND SPECIFICATIONS: t OF INSTALLA et 00 C' P c'sewer is-av in 16�00 1; 81a 'le wl lfh' 1 -6 Septic Tank: Distance from nearest well___t�!_!A/._Distancp from foundation_ _: __--___ MateribCONCJ------- NO 7_ Liquid depth- of icorrparfments------ -- _e__YY1a , .......;Capacity--/ ----------Si, 1 //1 5 Disposal Field: Distance frorwearest well-cl .-.W-Distance from fdundation--!- -- ----------Distance to nearest lot line_________________ 'f trench......36 - ----------- If 49 Wijfh"o ------ Numb& 0 lines----- YJ------------Length of each inl6ony ..$S Width ROIJCK_---Depth of filter Lferial:!,�!J_' ---- 95--------------------- Total ength---------- Type of filter material-'_ Seepage Pit: Distance to nearest wellDistance to nearest lot line______________ __ -t----—------- ------- ❑ -- -- Number Of pits---------------------!Liming material---------------------- Size: Diameter--_-------------- ----Deptn-..--------------------------- Cesspool: Distance from nearest well-j-6-1---------Distance from foundation-------------------.Lining: material__:------______---.____._____._._... El S•ze: Diameter-------- ------------11U--------Depth---------------------------------------1----------Liquid Capacity..-.------------------ -----gals. Privy: Distance from nearest well-_------- -------Distance ifroninearest building.__.__-----_.___-------------- --------- 'Distance to nearest lot line--------------------------------------------------------------y--------------------------------------I--------------------------------------- ❑ -------------- ------------- Remodeling and/or repairing (describe)- ---------------------------------------- ----------------------------------------------------- --------------------------- —.—.4 1 ---------- ---------------------------------------------- -------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ^^P , � -.6n---------e- 1 !.. I : I ----7------------------------------- ------------------------- ----------------------------------------------- --------------- --------------------- ----------------------------------- ----------------------------------------- --------I------------------------------ ....... --------------------------------------------------------------------------------------------------------- -------------------------- I hereby certify that i have prepared this application and that the work All be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - --- ---------------------- --------------------- - ------------ --------1-(Ow'ner and/or Contractor) ------------------ (Signed)----- ..... ------- ----- --------- ------ ------ --------------- ------- -------------- -------- ------- --- ------- BY:---- �------------------ ----------- (Plot plan, showing'size of:lotjo�qafjon ofsysfem,in relation,t,o wells,,,buildings, etc.,can.be placed onreverse side). FOR DEPARTMENT USE ONLY ------------ -- -- APPLICATION ACCEPTED BY__7_ 1_R__( .2 - -------------------- -------------------I-------------------- DATE-------- REVIEWEDBY------------------------------------------------I---------------------------------------------------------------------------- DATE--------"--•------------------------------------------- s ATE---------------------1-1------------------------------- I --------------------------------------------- BUILDING PERMITIISSLIED--------- -------------------------------------------- ----------------------------------------------- DATE--------------- Alteraii47ns—and/or-rg-comrhe—nda'fi6'ns:----'NV7-F--- --------------------------------------- ---------------- - E 0,.- -------------------------- ------------------ --re-4?------ ____ - ----------- -------------- -------------------------------------------------------- -------------------------------------------------------*---------- ------------------------------------------ ----------------- --------------- ------------------------------ ---------------- - --------------------- -- ----------------------- ---------------- ------------ ------------------------- -------------------------------- ------ ---- --Z------------- ------- - -------------- -.1----------------------------------------- -------------------------------------------- --------- ---------- ....... FINAL kINSPECTI -BY SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.NX111 Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,,California Lodi,California Manteca,California Tracy,California vy F.F,12.11.