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�ICE USE.. ------------------------ ------------------ ------------------------__---------- APPLICATI(5N-'FOR SANITATION PERMIT Permit No. _47�7�3 ------------------ ------ --- -------------------------- (complete in Duplicate] Date Issued --------- ----------------------------------- ------ ------------ ----- This Permit Expires I'Year From Date Issued ---W(1:; Application is hereby made to the San Joaquin Local Health Distri&for a permit to construct and install the work herein,'described. This application is made in coTpliance.with County Ordinance No. 49 ;3-510 W. "' 3 Z-/' - /7 JOB `ADDRESS AND LOCATI10 Owne�,'s Name--- - - -- ----- -------------------------- -- --- - --- x -- --- - --- ------ - -------------------- Phone-------- -------------------------- Address......Ir 0_04- -1 . * ............ ------- -- -L------- -- - --------I------------------ ------------------------------------------------------------------ ---------- Contractor's Name--- --- - ------ ----------- ------t---------------- ............ --------- -------------------------------------•..... Phone-----------------•----------------- I Installation 'will serve: I Residence rM--A—partment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ -Number of living units:_(--- Number of bedrooms .-,?- Number of baths.2---..Lot -size --- Water Supply: Public:system, c ommunify system El Private' E] Depth to Wafer Table Lo. ft. Character of soil to a depfh of 3 feet.--,,,Sand E] Gravel 0 Sandy Loam E] Clay Loam E] Clay 0 Adobe ffr"'H'ardpan El Previous Applicatio`Z M"ade:_(If yes,dcite_�4_7�770 -.No ❑ New Construction: Yes �r No El FHA/VA: Yes ❑ No E_TYPE OF INSTALLATION AND SPECIFIMCKS: (No sepfic,fank'or cesspool permitted if public -sewer is available within 200 feet.) t- Diitance from nearest we4rn77=77n__ ---Distance fn_�O�-, ------------ Septic Tank: iaerial... No. of compartments-----2n----------------Size-------_3rom foundatib'K-471�J---Liquid,clepth----- ----- ------------Capacity. Disposal Field: Distance from nearest weli-� _!Distance from foundafionlo...............Distance to nearest lot lines�f------- Number of knes----2—--- ---------------------Length of each -----...Width of trench--- ---- --- --------------------- Type of filter materiaI.e__/79.r/<_ IDepth of filter.n)ateriaI__/r_*-----------Total length- ------------------------- See it: DiOance to nearest well---—--------- Distance from foundation-----14-0..........Distance to nearest lot line---A........ A_------- , ;7j— �) I Number of ifs------1.0-----------------Lining M`_aferialr---?b V/vt/---Size: Diameter.3j Dept�--- ----------------------- Cesspool: Distance from nearest',weil---------------'i-Distance' frc;m foundation--------------------Lining material------------------------------------- - ---------- I Dept h-------:------------------------------------------Liquid Capacity----------------------------gals. Privy N Distance from nearest t -Di-------- - te from nearest- ------ ---------------- 0an + building----------------------------------- ...... 1-1 /Distance to nearest [of line------------- --------------- -- ----------------------------------I-------------------------------------------------------- Remodeling and/or repairing (describe): - ------------------------ - ---------------------------------------------=-------•--------------•-•-- :------------- -------- -------- 711--------------A--------------------------------- --------------- --------------------- ------------ - ----------------------------------------------------------=--- --:--- ---- ---- ------- ---- i------------------------------i------------------------ - --------------------I——------------------------------------------ ------------------------------------- -- -------------------------------------------------------------------------------------------------------------------------------------7--------------- - I hereby certify Wat I have prepared This application and that the work will be done in accordance with San Joaquin County ordino'nces, State law ..and r6es and 'regulations of he S' Joaquin4- Local Health District. (Signed)---- - ------- -------- ----- ---- ------ -- -- - ---------- - -arr4/or Contractor) - - ---------- --------------- --------------------------------By:--------------- --- -- ----- - - --- --- ------- ------- ------ icafon of ---------- ----------------------------(Title)--------------- ------------- ----------- --------- --------- ... (Plot plan. showing size,of.lot, location of sys em.in relafio�n to wells,.buildings, etc., can be placed on reverse side). ji FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ----------------------------------)--/DATE----- _A_ _�t---- --k -------------------- 11, 1 A7-�-7- REVIEWED BY-------------- •-------- --------- ---------------------------------K_ DATE----------------------- ----------------------- BUILDING PERMIT ISSUED--------------------6--• ------------------------------- ---------------- DATE------------- ----------- --------------- --- - ------------; Alterations and/or recon�menda f ions:--P.V _ Jv/c---- --------- - -4---------•---------------------•---- - ------------------------- ------------------------------- ----------------------------------------------------------- ---ly ----- ----------------- ij-------------------------------------------------------------- ---------- ------------------------------------------------------------- ----------------------------------------I------------------------------------ 1/ 4 -0-1 I`. . ----------------- ---------------- ------------------ • ------------------------------- ---------------------- ---------- ----------------- ----- ----- ----------------------- ----------:--------------------------------------------------------------------------------- I ----------------- ----- --- ----------------=--•------ ----------------------------------- - --- --------------------------------t -------------------------------------------------- ---------------------------------------I---------------- FINAL INSPECTION BY:------- .......... -------- Date-----------1�4 S XN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED EI-59 3M 3"63 F.P.CD.