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-------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No (ComPlefe in Duplicate) Z-7 s ---- - -- --- -=- ---- -- ---- -- --- --- ---- ---- " This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Locaf Heal+h District for a permit to con Date Issued:__ This application is made in compliance with County Ordinance No. 549. � - y strucf and install tfle work herein described, JOB ADDRESS AN p LOCATION_._._._.__-_ Owner's Name--------- ------ ° -- R`r Address ---------------- }}�� HRo t� =01 1.? _x------------- r��---•----4014 Phone:.----------------------- Contractor's Name____"____ "�"""•----" --•-Rpp_ f. vVAM -----------•----------- Y Insfallation will serve: Residence --"--.___ ""- ----------- � 1 ..�,_„�- ------ - - ----- Phone.. . Number,o ivl g Aunit,. ti i� Commercial 0 'railer-Courts c - Number of bed" 5'' ❑ 'Motel-,❑Other ❑ �` - ._ Number of baths _"-_ Wafer Supply: Public system ""�"- �-�- Lot size /11Q�"x*"/p©"' y system ❑ Private ❑ Depth to Water Table : "_ " Character of soil to a de pfh of 3 feet. ' Sand � t Previous Applicafion'Made: (If es da 'Gravel ❑ Sandy Loam [ CIa Loam Y ❑ Clay ❑ Adobe E] Hardpan ❑ Y to ----- ? No TYPE OF INSTALLATION AND SPECIFICATIONS: New CoCnstructron: Yes A`IQo ❑ FHA/VAI Yes� No --- _ -fano ❑ (No septkr cesspool permit#ed if public sewer is available.withirl_OD Se tic T nk: - _ p Distance from .. - "� } nearest wet - pleance from found' `""�` �~ �-�• - i �M Nb. of compartments_.--- -- etion___ :----- ..Material__ 'r f------- ___ _ trxi_ O x"" Lquid depth--Al Disposal Field: Z____-:Ca acct NDistlance from nearest well._.-�--Disfance from foundation__. p umber of fines----------�f - Length of each line_Ya_L-7A3" 1�-Distance to neatrest lot ina___ is _ -- �. .�ype of filter material-A-0- aterial__ (7_ �« Width of trench_.__� �s� Seepage Pit: CK Depth of fitter material----- l r` rest t / ------.------Total length---- � ---------- Distance to nearest well-_-_-1--__ - c� .. "___"Distance from foundation________._"_"."__-.Distance to neaesflot'fine_""-_-_"""------ ❑ I�umber of its g I t �.:. p Linin material_- - --.------- Size.: Diameter - Deptn_ ---- 0 Cesspool: N,��r,0 ❑p Dasfi'ance f o nearest well fromfoundafian_._- ""_"- _,""_.Lining"material_"-_ "_ Size: Diameter:--------------------------- G +r, , Depth'�: _3 U� Privy: Distance from.nearest well----------- Liquid Capacity--- _" - gals. ❑ Distance to n�arest loft line---------- __ Distance from nearest building ------------------------------- -------------- --------- - et Remodeling and/or repairing (describe)------------ - - --•--•---------•------ ------------------ --------------1 a L - >I -----------------•--•---• -- - -------------- ----------------- --------- ( ,. -- .. ,. , --- --- --------------------------------- - I hereby certify that I have prepared this application and }hat the work will be done in accordance with San Joaquin County - - --- �_ - - . . .� -- ---- -- ---- --a---- or inances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------- 9-------------- 4 3 _. . By:-3�--_._, -"a _ (Owner and/orContractor) : „�-� --{ d/o (Plot plan showing. it``-" `�'° - ----- —4 --(Til " size'of lot, location of 6s stem Inge ati n to w -- el s�;'bullc�in'gs; can be plat on reverse side]:"'`"' FOR DEPARTMENT USE ONLY, T APPLICATION ACCEPTED BY_----"-- --_i_ - � I REVIEWED BY-- -- �- ------ ---------------- -------------=---- -------------------- DATE ---- ----�-��-�-�->` BUILDING PERMIT ISSUED-------•------•--------- - - ---------------------------- ---•----- -- ------------- DATE-- --� -----------�- ----- ----------- - -------------- #erations and/or recommendations. ............ DATE ---•------ ' ---- -- ------- ---------•- _-- - ,,�; -- -- --•-- . --------- a . ---- --- -- - t ---- --- ----- --- -------- -------------------- ----------------------------- FINAL INSPECTIO ° --- ------- ---- -- Date__. 3d SAN JOAQUIN LOCAL HEALTH DISTRICT w 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California `a 205 West 91h Street S, Manteca,California Tracy,California ES 9 REv�560 8-59 3M 3•'63 F,p,Cp,