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FOR OFFICE USE: --------- - Permit No. .. ..... ---------- -----------ell�_ij /PPERMIT APPLICATION FOR SANITATIO -------------------- (complete in Duplicate) Date Issued This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and instail the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDL - --&-i ----------- - �` - ----- k----------------- Z Phone....%4( Owner's Name------ -OCATION__----- ......../. ..... ---------------------------------------I------I----------------------------------- Address---------------------C -------------------------------------------------------------------- - ------------ ---*01 Phone ---------- ;�� Contractor's Name---- A ial E] Trailer-Court 0 Motel Other Installation will serve: Residence n Apartment House: 0 Commercial --- --------- -------------- Number of living units: ___E---- Number of bedrooms .1Number of baths ---t--- Lot size ---------a---- - Water Supply: Public system El Community system El Private Depth for Water Table ------ ft. -- -0Adobe®' Hardpan Cj Char'a�i�tei-of's'oil'f6.'a'de�th-of 3'feet:' S9;d E] Gravel 0-Sandy Clay L7o"a70-Clay Made: (if yes,date-..-- New Construction: Yes No 0 FHA/VA: Yes E] NoN Previous Applica+ion At --------------- No TYPE OF INSTALLATION AND SPECIFICATIONS:! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well__I_P4�.......Distance from foundation----1-jq ------- Size_3__)C-_ h.......:f..k---------- ---644n- 4" No. of compartments--------lrr7----------- _5---- ---Liquid dep� on -_Distance to nearest lot line---A.., ........ nearest well---1-0.0.......Distance from foundafi -_ Disposal Field: Distance from I - 7_-----------.Width of tre� h...... ------------- Number of lines-------------------•---------------Length of each line---------1-0--------------W ';. r1loC 0 - -------Type of filter Dept'r.of filter material---- length_________________________ I -.Distance fc� nearest lot line-k--A--- •S% Seepage Pit: Distance to nearest welL.. J_P_P_'__-'__'_Disfance from foundation------1-02-_ -0-------------------' -- -4 41-*,'V--S_ize- Diamefer.-.-.3-3...........�De'pfh--- ----------------- Number of pit$----------1�------- 1 ng ---Linimaterial--r ----------------- -1ining materi'al-------- ----------------------------- Cesspool- Distance' from nearest well_ Distance from foundation------------ ----- -------gals.Z ❑ Size: Diameter---- -------------------------- ------:.Depf h---------------------------------- ----------------- Capacity-.----------------- i Liquid. Capacty-.----------------- - - Privy, Distance,from nearest well-------------------------------------- -------- -Distance from nearest 15uilding -------------------------------------- i---------------------------------- Distance to nearest lot line------------- ------------------------------------------------------- ------------------------------7 ❑ Remodel4inAg-and/or repairing ------------------ -- --- - I II - --------------- -_-_-_---------------------- - V01 - --- - -------------------- ------------------------------- ------- ---------------------- ---------I------------ L i ; �7--------- I------- - -----------I--i-------------I------------- t---------------------- -- ----- -------------------------------------------------------------------------- -------------------------:------------------------------------------ pplication and that the work will be done in accordance with San Joaquin County ordinances, I'hereloy certify that I have prepared this & Inces, State laws, and rules 9nd regulations of the San Joaquin Local Health District. -------------------------(Ow:ner and/or Contracfor4 tSigne!d)----------- ------------------------------------------ ._r-------------------------------------------------------- ---------------- ----- ------ By:_---------------- -----(Title)-------2s' _L------- --- ---- ----------------------------------------------------------------- ------ tion o"system in relation to wells, buildings, etc.. can be placed on reve;se.side). (Plot plan, showing size of lot, location F. . + FOR DEPARTMENT USE ONLY ' '94 CATION AC CEPTED BY_ -- -- ----- -----I----------- DA TE A --------- ---------------------------------- REVIeV4ED BY-------------------------------'---- ----- -------------------------------- - - DATE_ - DATE --- -- ----- - --- ------- -- BUILDING PERMIT ISSUED-------------- ------ Alf,ra"fi-' —san- recommendatio -------- IN . . --------- ------- _r---------------------------------------- ---------------------------------------- -------------------------- ...................... . ......... ....... ...... . ----------------- 4, 4t ----------------m------------------------------------------------------'------------------------------------------------ - --- -------- -- ----------- ---------------------------------I------------------------------- --------------------------------------------------------------- ---------------------------------------- ----------------------------------------- ----- ------------ ------ ----------------------------- ---------- ------------- -------------------- ------------------------------- ----------------------------------------- - ---------- 41� . . " 6ate .... . ------'--------- FINAL --- -----------FINAL INSPECTION BY:_ ------ A k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street - - Lodi,California Manteca,California Tracy,California Stockton,California L:3 9 REVISEO 93-S9 3M 3-'63 F.P.0O3 *%,