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FOR OF-10E USE°�'� �4..:� `ADD 1 ' ---( -"a---�- Permit No. •---•--- -� f�- - - a APPLICATION FOR SANITATION PERMIT . . L [ (�,"C2-.-i �.3:J-- (Complete in Duplicate) Date Issued ' -�� 1This Permit Expires 1 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. �/j -,0 ?t--2�-&3 This application is made in compliance with County Ordinance No. 549. �,. G :- - w l$.3t Tit s7 u c t I — ---- - VL �- -_ JOB ADDRESS-AND LOCATION_/ -- ---__."--------------------------- Phone------------------------------------ Owner s Name----------- Address----------•----------- •-- --------- --, • ----�----- Phone. Contractor's Name----------- - -- � '� ' = _---------•------------- Installation will serve: Residence L� t` artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ L/ .•------------- -"_"_ Number of bedrooms ---7-_ Number of baths "�-- Lot size "-,�-�_ �� Number of living units: -� �ft Water Supply: Public system 171 Community system El Private [Depth to Water Table V . � Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ S•andy-L-oam-❑ C-lay-Lnam- C-lay 0 Adobe Q Hardpan ❑ Previous Application Made: llf yes date."__- ) No j New Construction: YesX' No ❑ FHA/VA: Yes E] 110 0 t I TYPE OF INSTALLATION AND SPECIFICATIONS: i R (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .- yID e, from foundation_-__ d4e........ ".•h-_""-. Material ra=t-e'r'i-al Septic Tank: Distance from nearest well-.40--------Distan -------- -------------------------- ------------------- CaPautY-Z-a- ----VN No. of compartments--__-.p2-`------- -... K ----Liquid r f { 1, Disposal Field: D+stance from nearest well-,S-0------- Distance from foundation---.,l.d""-_---.Distance to nearest lot line- ""-_-__""_"""" Number of lines--------j-" LengAl of each line--""_.7,::1 _---- ;---Width of trench--....... �--- *-------- I`fl Type of filter material""5i_ -c-/ --Depth;of filter material----._ ...Total length-------------- _----- s j Seepage Pit: Dista'ce to nearest well_/O"_0__..- �DistanV;_1411 m foundation-__/d_-----.Distance to nearest lot iine�_.�"".�"._: Number of its._. ---77- Linin material -- "-Size: Diameter"-".3. --- _..-..-Depth------�5----._--- ,,. Cesspool: Distance from nearest wel!-----------------Distance from foundation_- _" -_Lining materia"".-------..__-.----------__--_" � Elt Size: Diameter- ---------- ---------- ----------- ------------------ ------------------Liquid Capacity - gals. E• d1stance from nearest well-------------------------------------_-----.----Distance from nearest buildin f' k1] ' -------- ---------------------------------- - � Distance to nearest lot line------.----------------------------.-------------------------- i a ' -�---- �O --- Rem_odeling.arid++/bF repaErtng [descnbe]:"-- __ I •- ------------------------------------------------------------------------------------------ s --------------------------------- ------ -----------; ---------------------,------------------------- ------ ----------- , ication and that done a 'l I ordinances,ereby certify.f lawsh etndhave ulespandared this al olf the San Joaquin Local kHealth eDis+r District accordance with San Joaquin County ate - - , ----------------------------------------------------[Owner an orContract (Signed) By.: :fit ' -------------------------------------------{Title}-------- (Plot plan, showintg'siie of lot, location of system%m_rela+ion fo wells, buildings, a+c., can be placed on reverse side). s 1OR DEPARTMENT USE ONLY t l ---------------- APPLICATION ACCEPTED BY L =- --- DATE — C Z --�{ REVIEWED BY------------------------------------------------------ ----------------------------------------------------------- DATE -- --------------------------- ------------------- DATE f - --� DATE------------------• ----------------------------- BU I LDI NG PERMIT 155U ED -------------- ---- ------------------------ --& -------- -- Alterations and/or recarnme dations:-.. _" ---: -- "" """" ' � < f r, ---------------------- .' J� ` ---c_ -''i �`' -- -------- _ ---------------------- ------ �.� ��--------�'s� 1 -------_ 7_77 -�� - "` _ � --- �-_� ' —' c1 - / • ---- -- - -- - - - -------- --- ----------------------- FINAL INSPECTION BY:._ ..,-..... Date------- ---------- -- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300'West Oak Streety •l2k Sycamore Street 205-West 9th Street 3 ? a . / Stockton,California Lodi,California Manteca,California Tracy,California 4 ,^ +x