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FOR OFFICE USE: S;r ------------------ ----- Permit .No. ..� 1 -- ---------------------------- ----------------------------------------------- APPLICATION FOR SANITATION PERM !3, (Complete in Duplicate) J ------- --- -•-- ---------- -•----- - :---- --- -----.. , � � Date Issued This Permit Expires 1 Year From Date Issued ------------- Application is hereby made to the San .Joaquin Local Health Distrl�t�for a permit to construct and install the work herein e�sc`r�� This application is made in compliance with County Ordinance No:-549. /per Q �f~'1` 0 �A � M ® -U.4#-i �!-!- -- JOB ADDRESS AN '�OCAT ON_..___ _ __C��-�-�,��------ •----- - - = -- _ ------ �p Phone ---- Owner's, ---�, Owner s Name_-__'___ ----- ----- ---------- 9-_ ,c Address------------�.r-.r�----�--�---------�--•--�-�---------- •----- --._ --- h ------ - -----•-- ---------- � ---------.-P one-------•--••----•------------------ Contractor's ----------------.Contractor s Name--- -----��N� -- --------------------•------------- -- --------------------------------------------------- Installation will serve: Residence � partrnent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑,, Number of living units: -1----- Number of bedrooms 4---Number baths ____.___ Lot size-- .• Cornmunit s s m ❑ Private Depth to Water Table3�5 ft. P, Water Supply: Public system ❑ Y Y i l Character of soil to a depth of 3 feet: Sand t / Gravel p S dy Loam ❑ Clay Loam [Iafy ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_.___.-__.,_____-I No New Construction: Yes . No E] FHA/VA: Yes ❑ No TYPE`bf INSTALLATION.AND SPEC IFICATIONS:__-a,F. (No septic tank ar cesspoo permitted if public sewer is available within 200 feet.) j I Sep#iC' _ Material-------`f ri-�-=�-r ---------- - -- ----- .r. n :.wwm.rDistance,fro--mrteV:nwestiwell___ __ �_____Distancefrom foundation TjN� No. ofCompar --------------- ----- ----Capacity---_- --- __ tm , ---- --- } J—Distance to nearest lot j Disposal Field: Distance fro#nTnearest well.-._____ __.. Drstance from foundati n---- Width of trench_.__.:_02� --- ----- -/- ---- P of each line ��. 'S lCn °� ----Total length ry?' 0 Type e of fis ernmaterial______ Q_C _ Depth of filter material_._-_ g ...� Yprx kms„-.. - Seepa it: Distance to nearest well_____________________D'Istance from foundation-------------------- to nearest lot ine_____.__.______._ Number of pits---•-----------------Lining material-----------.----- ---Size: Dlame+er------------ Dep#h Cesspool: Distance from nearest well----- from foundation....____.___'------.Lining material ------------- __.______ ❑ ---------Dehih- '!�------ -' = .- Liquid.CapacitY-- -------------------------gals. Size: Diameter. Privy: Distance from nearest well _ 7 ----------------Distance from neare building-------.___________-------------------- ❑ Distance to nearest lot line-------- ------- - • - ------- ! : Remodeling and/or repairing (descnb$):_.___j1�� - - -��- - L c . 7u --------=�.ltrTct ��t��l^ �r- 7?F ' 7� } f . fil " 'T r - --- ----- p �p .` } � - sork wtlli be Bane in a cordance with San Joaquin County ! hereby certify that I have re ared this a r Iication and,that they ordinances, State laws, and rule and,reg cations of.the`+San floautn Local Health District. t, nerContractor) f (Signed)_.f� -----------•--- --- -- - s,#-�� -�`-- ------ ---- ------- -� ------ --- --:------- ---}��__a0T�yn /,°�r � --� ---�- _w � :ter 1 -=---- „�;. -�� -_ �Tifle)•------ -•,44 r-.-=------�• BY -------•--------------•------------------ - ----- O (Plat plan, showing size of lot, location of.system.yin¢relation,fo;wells -9 Ac.. can be placed on r . ;se side). FOR DEPARTMENT USE ONLY All DATE 3=------------------- APPLICATION ACCEPTED BY-77-JR-0-i- - -------- ----- QDATE------------------------ - ---- BUILDING PERMIT ISSUED---------------------------------------------------------------_.- REVIEWED - ---- 1 � --------------- ------------------ DATE.---,-----.-------------`------ --- :-----;------------ -- f_ Alterations and/or recommendations: -- -------------------------------•-----= rF------•--- = te== �r--------------- ----- �C tiK -- ---------------- Z-t r { 1 .4G-1-l- ._wLJ�FnL ; 1�1H ° Rc` I� Tt�t — Rt �_ a_Ti�nl Pf P f -'-7-- --------13 RI 6G__•-..f-�#.i ---------}�--GTF&q•--- ----- . �1 t1 U�T ��{d'7-� �jN��S�A t�f� •:: ' UNDER �C96�h�C�J r�'!ST/��C�S d---.!� STN�T `-- _ Date_=__~.• .fr '...1 G FINAL INSPECTION BY:__; .-- �- ----- a�-+�� -= ---- - �� , i f ,TV> � [Q4��J�QUIi�L�OCAL HEALTH DISjR�IC e� • 1601 E.Hagelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California A Manteca,California Tracy,California � E5 9 REVISED 6-59 3M 3-'63 F.P.CD. '"'��