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FOR OFFICE USE: ----------- - ------------ ,( APPLICATION FOR SANITATION PERMIT Permit No. ....�_-_.� .. .. --------- ------ ------------------------------- --------------I----- (Complete in Duplicate) 'pate Issued ---�,--_1-•--(-y I--------------------------- --- This permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ism dein compliance with County Ordinance No. 549. ' — Fscoi-O JOB ADDRESS AND LOCATI ------- u�1 _ �� - ( r�-------------- Owners Name-------------------F------ ----•-•- f��-----'L•'- ------------- -------_- ------------------------------- ------------ Phone------------------------------------ x-�--' - -- -- - - - - Address ` 2-----•- X -- - -------- - -- -------- - --- -- - - _ �V. , Contractor's Name---R�IQLV--I ----••-------- ------------------------------ Phone., • Installation-will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----_:Number of bedrooms __3_ Number of baths j__-- Lot size --- .x--- -'------------------------- Water Supply: Public system ❑ ;Community system ❑ Private )Depth to Water Table 17po ft. ` Character of soil to a depth of 3 fde+: `Sa'rid`�Gravel ❑'�S n$dy Loam C1 Clay.sLoam ❑ gay E] Adobe E] Hardpan E] it If Previous Application Made: (If yes dates:_ • -_ )-�No -New-Coristructlon:-Yes o QF FHA/VA: Yes No ❑ -TYPE OF'INSTALL'ATION_�AND7 SPECIFICATIONS: (No septic +ankor cesspool permitted ed if sewer s(`..avatlalybwithin _ 200 feet.) SeDistance t well ------D-istant from foundation- MaterialT<. --- C :�Z--�©�- iquid depth_ - -------Capacity-_-000mparmentseL �---- - ; Dispos 1-Field: Distance from nearest well....... ..°Distanc from four'dation-:--_- O-------Distance to nearest lot line_---__5--._--- T e of filter ate-------RQG-1� ---.Lengtho f each line---�iP�-2p-----.Width of trench--------3 .-ff Number of lines -�� - e Yp `- I� r length J�Q Pit: Distance to nearest wells----_-_--._-_ Distance from rfoundation--------------------Distance to nearest lot line----------------- Seepage ,. I � --- 0 pi,„-------------------- Lining material-\---->--- --------Size: Diameter. ------------------.Depth-----;--------------------------- humber of its - r � 's Cesspool: Distance fro; 'nearest well---__ -_-_-Distance rdm foundation.---.-- -__.Lining material---------------_------..-____..-----. d Size: Diameter- Depth--- = ----------------Liquid -Capacity-----------------------------gals. Privy❑: Distance Bram."nearest..well------•---------� ----------- -----:- __-Distancem nearest building--------------_-------------=-------._. ❑ Distance to nearest lot line------------------------------------ ----------------------------- =------------------------------------ t ." - Remodelingand/or repairing (describe)=-------- - ---------------------------------------------._...------------------------------------------------- -----• ---•-----------••-------------•-- ---------•------------------------- - i -------------------- `; F` • ` r,t+ 1----------- # ------------------------------------ ------------------------------------ ----------------------------------- -••-•-----------------------:---------- ' -------------------------------- ------------------f--•--------------------------------- ----- -----------------------------------------1---------------------- ------- ---------------------------- - I hereby certify°#ha it have prepared this application and that the work will be done,in accordance with-San Joaquin County e w ordinances, Spats, and rules and regulations,of..the,San Joagtiin.,Local,Health.D•i_strict. (Signed}-_'I_ ---------(Owner and/or Contractor) } ------- - �.c ., . By (Plot plan, showing size of lo+ location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY..---:------ ��C =----------------------- --------------------------------------- DATE-------3--------"sr�'/ _4 x--------------- REVIEWED BY ------------ ----= ------------------- _ ----------------- -------------------- DATE---"------------------- BUILDING PERMIT'ISSUED "". '°= "= ""=- --- :' � "--==------ Alterationsand/or recommendations: --------------------------=---- ---------=------------------•--------------------------------------------------------------------------------------- &,.r-FK 4.1 s ,0, 1-� --------------------------_----------_------------------ ------ - --------_--- --- --.-_- -_-- _ -----------------.-----------------------------------------.----------- ------------------------------------- _- _----------------------------- __--_f ----- _ Date--. --- -=. FINAL INSPECTI Y ---- - ----- - --- - - --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1lazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r E5 9 RrcV45ED B-59 3M 3•'63 F.P.CO. 1 1 I !