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i .. Ut APPLICATION FOR SANITATION PERMIT Permit No. _//��(p..:f._.. t (Complete in Duplicate) 71 - t . _ _ .. _ Date Issued! r� T li ation is hereby mads to�fhe San iJoa Joaquin Local Health District for permit to construct and install +h work h rein described. pP Y d� G p e e desc bed. This application is made in Go mpliance with County Or nce 9. JOB ADDRESS ANTION------ A ----------- �= ------- -- ------ �..--.-- _ -� --•_ _.--a �-_ -Owners Name- ---- T-•-- -- ----- ------ honef ----------- Address 44 -------------- .., Contractor's Name - ��---------- ( I !`�✓ ! ' .. Installation will serve: Residence�'0 Apartment House' ❑ Commercial ❑ 'Trailer�Court ❑ Motel ❑i Other ❑ Number - � of living uni�:` �x'�N;tuber of bedrooms -;x_ Number 'of baths ____ ot size .--------C�-t.1____��_�__-_.f____ _________ Water Supply: 'Public,systeI ❑ Community system ❑ "Private L4-1�ppth`to Water Table ft. Character of soil to a depthof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El'-Hardpan ❑ Previous Application Made:uY s,❑ No j&- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 0 - TYP INSTALLATION AND SPECIFICATIONS: {No septic tank or"cesspool permitted if public sewer is available within 200 feet.] f Distance from nearest well----------------_Distance from foundation________-______.Material-------.___"�- "________________...___- p .. x_ __. ;SizNo. of tm arfimants________________ e_______________�___________.___Liciuid depth______.___._____________._Capacity_...___________________ 4- osal Distance � ifrom nearest w�ll__ V-__-___.Distance from foundation w� __.__.'_..Distance to nearest lot o Number s f linesr_____ _______ _ 'Length of each line----' _Q - s/ Width of trench___ ` ��________._:__ TypeDepth of filter material'__- __--. Notal length__/�_E--- ----------------I..._.__ e it: Distanocey tloeneaa striwol:_ __ _____=_Distance f o ounda+ion_ -----------Di tante to nearestsof line---- Number )f � ` Size: Dia meter--- y — Cesspool: D sfiance from snaarest-weJl-"-Linin----;'-'D stanlc�e from oi -�-->"""-.Dep#h��_f__�____--__"__-_ p. - g --------------- .-Lining material-------------------------------------- N undation Liquid Ca acit k ❑ Size: Diameter Depth q p Y----------------------------gals. Privy: Distance from nearest we'll'_____________________________________;____-_-Distance from nearest building Distance to nearest lot line- `.. ,.- "2--------------- ^^ - ----------- -------- - - Remodelir�g and repatnn, {deAl scribe) f �' '� n r' r --•------------- ------ --- ->_ _ -- f.* . .�pC`. - ' •' -_ OJ �M ..__..._ _y ----- •------ -• • ------------ --------- ---------- ------------------------------ ---------------------------------------------------- -------------------------- = -yp------ -------- ----------------------. ---.__ �.� � , r I hereby certify-that I have prepared this application+and that the work will be done in accordance-with San Joaquin-County ordinances, State laws, and' rules and regulations of.tha San Jo In Local Health District. N � ,�-- t (Signed} --- ----------- ----- --`----- - ` ------ Contractor) F By....- - '- ------ -----{Title} ------------- ---- --------- -------------- = ' (Pl t plan, showing size of IA location of iy in relation to wells, buil rigs, etc., can be placed on reverse fide). L FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED�BYR -- - - -- ------------------------ ----- DATI=_�---------------- --`-- --•------=-------- - --- REVI�WED BY =.. ' ------=----------------- --- -------------------------------- DATE p4 { BUILDING PERMIT ISSUED-111-.-----�`"---- -------------;----•- --------------- .- DATE------- ----------------------------------------------- Alterations - -- - Alterations and/or.recommendations-----------------------------------------------------------=--=--------------------------- ----•-•-----•------------------------------•------------------ -- V - . - - r_ ---- a ^/r.+ 1. �4�i ------------ ---• --------------- -- .�i__._ .e-� A ------ /' ✓ ' 1'�-- _ f�!....._�r_•�F_, -------------------------- -------- -----------------------------------.G.�-S_e-�9_t_� •--------------- - ------------- ---------------------�------------ -- ---=JT------�� ; c �� - -- -•- ----------------- ------------------ _,V-47-41 FINAL INSPECTION BY:_--- ------------------`' _ - _ Date-----ZP?-102-6---Ls- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton,,California I Lodi, California Manteca, California Tracy, California .I ti ES-7-2M , Revises 1.57 IPco-