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FOk OFFICE USE: / S APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ---------- This,Permit Expires 1 Year From Date Issued Date Issued __ -bra_ Application is hereby made to the San Joaquin Local Health District for a,permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION _ L - -- 4AI---'-------------------------------- ----A --H- 0-P--------------------- .-�_L 1'-- _ ------------��1f ---- -------------------------------------------------------- j Owner's Name-----------•- � �� ------- Phone_- -• -----------------•--•-------- Addresso_ , . 1 H '4 -��-�'--------------------------------------------------•- Contractor's Name-------O_ - -•-•----•--• -------------------------------; ----------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai;le_r Court ❑ Motel ❑ Other ❑ I Number of livingunits: Number of bedrooms ___.____ Numb �------ � er of baths I---,;—, Lot size ---ff1P_>SJQeD-------------------------- Water Supply: Public system UEr"'Community sy m ❑ Private ❑ Depth to Wafter Table _0 ft, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hard an ❑ Previous Application Made: {lf yes,date-j-72-7-Y-) No ❑ New Construction: Yes �o E] FHA/VA: Yes Hard ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ^�(N��ptic.,tank or cesspool,permitted,if�_pubiic sewer is available within.200 feet.) Septic Tank: Distance from-nearest well---,.------- Distan se from foundation.--------_----------Material __ _ ________________ --------------------- F-Ar-6 T)rl G No.}of compartments---._- . ` ,----.__Size_________------------------______Liquid depth~ .~Cap city ____..________._..___ Disposal Field: Distance from nearest well'f ;'Y�1f'.-.Distance from foundation---J _'_ Distance to nearest lot line__._________ g 6 s� �k�t]S�JLY �.- Number of lines--------- -_ Length of each line____._ _ ______`_.Width of fire"10-.__ _.__.� ._-____.-- `i" �Dr�, Type of filter material___ . _.C__K__Depth of filter material_____,_ _ Total length--!------------�Q_______________- I ll��rr Seepage Pit: Distance to nearest well----------------------Distance from foundation~_____---------- Distance to nearest lot line----------------- E] Number of pits---------------_______Lining material-----------------------Size: Diameter.----------------------Depth ----------------------- Cesspool: Distance Distance from nearest well----------.------Distance from foundation._'-_------- - _ Lining material---------------------- ❑ Size Diameter-------------------------- -----------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------- --- -----------------------------Distance from nearest building------------------------------------- --_. fi : istance to nearest lot line-------------- D -----------------=-------------------y-----------------'------ ----------------------------.----------------------------------- Remodeling and/or repairing (clescn PiT __2LO-----jv_. -------�1� _ •[-`� F_-�_.----I--a ---*-- t�_��.ut_.j .rv1 ------------- --- ---------�-------------- - . , ., Yom . --------------------------------------------------------------------------- ------------------------------------------------------------•---------------- -- ----------------------------------------- f 4 t ---- --------------------------------- ----------------------:-----------------------------•--------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, t M� (Signed)------ -�C/• -Xt- - - ---------------- --- -------- ------------------------------------(Owneknd/or Contractor) • (Title)_ "" --- (P.IotTplan-,_showingYsize of lot rlocation.:.of.=s stem.in,relatian to we}1s,�buildin s, etc., can be placed,oweverse-side)_� �..... . . r FOR DEPARTMENT USE ONLY 4 - APPLICATION ACCEPTED BY fDATE -------------��---_------------------ REVIEWED BY------ -------------- ---- ----------------- --70-- 1--F ------- DATE --------=----------------------- " �: BUILDING PERMIT ISSUED `V7: �p DATE -�---�-Ply-T-i-Pj t;�:--- AI#era#ions'and/or-recornmendai:ions:__,61Y - ._ - 0$01 __ :a-y- - ---------------------------------- _______________________—._____s1.`�.f____(Ci _.._._.L Y✓i�t _:_.. J t: _ __ _____._�- ____..__ f --. - ---------- -------------- -- --- - ------ ---------- - -----=-----------------------Q ----�------------------ FINAL INSPE, Date------. a- .L`+f... _ - ------ ---- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.CC.