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FOR OFFICE USE: ------------------ ---------------------------------- --------------------- ------------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No, I ------- --------- ------=------- --- --- (Complete-in Duplicate) Date Issued ------------------- --------------- ....... ... This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Health-Disfrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 949. JOB ADDRESS AND>LOCATION4. - ----------�__j--------- -- -- ------------------------------------------- ------_----------------------------S Owner's Name"___________ - - ------- - /PW ------------ --------------------------- ---7. --------- ------ ----------- Phone- Address--, ---------- _1--- ---O .D Z --------- --------------- " -------------------------- ------------ . ..... Contractor's NameU . --- -r T11�* In,lallalion will serve: Residence [Apartment House E] Commercial [_1 Trailer. Courf\ Number of living units- Number of, bedrdo—ms 'IM—ofel El Other El W - 3 r f SIZ, ------------------------- -- Water Number of baths &&tx_- Water Supply: Public system E] Comm U4441,,_�Iyttemf[:1 Private P?"'D_e-pth to WaterQll� yj.1- tab I e 46off. Character of soil to a depf h of 3 feet.4a and E Gravel vel [:] Sandy d y Loa m D C* L!qam ElClay F-1 Adobe Hardpan .- 4.'oe I I'\ Ile- us Applica-flo-"n �Macl :, (If 4,date...... ❑----------- Previo No New ❑Construction: Yes [] 'N,*- FHA/VA: Yes E] NOE] TYPE OF,INSTALC, 16 FID-wS'PEGIRICATIONS: X -1, cess 43�� permiffed-ifpublic septic tank 'P -sewer-ts-ayaiIa6Ie_-Wi4hin 200 feed Ser , .. anc t-t from neallest well___."_Distance� -�_Disfance from Inafi - I clon----------1---------Material -- ---------------- ------- -------------- N1 of compartments------------_,21 ..._-Size--------------------- -----Liquid depth------------ ------------Capacity----------------------- ,f Sd apacity----------------------- sa. :4 Di9fance from nearest well:5/- _? nddfi0n----/Is7�_Distance to nearest Ipt Iine____/0_:7- L fh of each Width of french__C:q41_�x/ NImber of lines________ i?&�Disfance from 4 eng -vpe,-of.f*ilfer mate - -----------;;e------- o aferial----- -----Total length---------------- 1-- - __49-------------- Seepage Pit DJ74nce to nearer --------Distance from foundation---/-,tbF---Distance to nearest lot line-- Z'_'l jNun) er of pits-_ -------------Lining material-RQ ------Size: D'amefer.,Zz.�f Depth--Z's-------------- Cesspool: 'Distance from nearest well-----------------Distance from oundat;on_--- -------------Lining material_.".---..-__--._______________ --- El Size: Diameter---- ------------ ----------------_Depth---- --- --------------------- - ---------------- _Liquid Capacity-.----------------- -------gals. Privy: Distance from nearest well------------------ ------_-------------------.-Distance from nearest building--___.--__-__-__--_______ _ _ -------- n -to nearest ]of linetat - - ------ ---------------------------------- N Rem delin an it �,8pair`ing (descr b ----------*1- 4 i -------------------------------- i ---- _"_---_----V --------- ---------- -------------- . .... -- ------- ----------------------------------------- --- --------------------------------------- --------------------------------------I------------------ ------------------- ......... - ------------------- ------------------------------------------------------------------------------------- ---------------------------- ------------------- ------------------------------------------- ---------- I hereby certify that I have prepared this application and 0a the work will be done in accordance with San Joaquin County i ordinances, State,I and rules and regulations of the San Joaquin L al Health District. ) laws, [Signed)---- .... By:-------------------------- --- ------ ---- ------ N ------------ (0w*16Contractor) ----------------------------------------------------------- -------- ----(Title)- ----------------------Z---------------------------- ......... (Plot plan, showing size of lot, location of system in relation to Ills, buildings, e ., can be placed on reverse side). FOR DEPARTMENT USE ONLY �13 0 APPLICATION ACCEPTED B�Y___.__ ---- ----- A -1 - --- - ------- ------ -------- ------------------------------ DATE------------ (4 40 --- ---------- REVIEWED BY . . / ------ --------------- 1. BUILDING PERMIT ISSUED------------- ----- ------------------------------------------------------- DATE----------------------------------------------------------- ----I--------------------- DATE--------- ---------------------e5------------------------- ----------------- Alterations and/or recommendations:__..______._. ----� l� —-- -------------- -------------------- ------------------ -------------------------------- - ------------------- _�--------------------V- --------- ------------ ------- 4�—---------- ?777—_...... ----------------- ------------- ------- r=! ------ze��-- -!77�------!T�� ------- ...... ... ------ ----------- -------- 6 E dJ ............. -- ---------------------------------------------------------------------------------------------- ------------------------------- ------------ .... ------------------------------------------------11----------------- ------------------------------------------------------------------------------- ------------- ------------------------------------ FINAL INSPECTION BY:----....__". ----- --------------—- ------------- Date------------- -•-If IV. —-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycomore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.12-0.