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FOR OFFICE USE: ------------------------ -------- ------- ------------------------------------------------------I-- APPLICATION F611 SANITATION PERMIT Permit- No. ---------- -------= _------------------- -------•- -- {Complete in Duplicate) ----------------------------------------------------------- This Permit Expires I Year From Date Issued 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 is made in compliance with County Ordinance No. 549. F_ 61 i)5iq JCB��kDDRESS AND-L9CATION._1 '.,__ __C-_AL0Af -4 -- - ------- -------- Gwner,'s Name------------- ........ -------------------- -------------------- Phone------------------------------------- A_cldreTs,.-----------------P. - -----------------------------------------•-------- ----------- --------------------------------------------------------------------- _..�fpt--- - --------------- ------- rie to�s Qmen_ 6 A rt Contractors ----- W---If --------------------17- ---------------i I-------------------- Pho ..........................--------- Apartment House ❑ TInstallation will serve: Residericell Commercial [3-' 'Trailer Court E] Motel 0 Other,[] Number of living units: - ------ Number of bedrooms ,__ Number off b`afhrs',,2-__-Ldi size &G-7� ----------------------- Water Supply: Public.System*'Fflj Community system E] Private 0DeP7 to Wafer Table,3574. Character'of soil to a Idepth of 13 feet: Sand Ej Gravel E] Sandy Loat [j Clay Loam Clay E] Adobe E] Hardpan Previous Application Made: liflyes,date--------------------) No 22-" New Construction: Yes ED FHA/VA: NokE�- —TYPE�OF__INSTALLA ON AND SP_EGIFICAfiO_NS-_ ,(No--septic-tank' or cesspool�perm!Ae_d if,�.ppl�lic_sewer is available within 2004ee 11., , !. Septic T nk: 4DD Distance*rMnearesf weiI ,,5, from foundation____. .-----/0--------Material__jo��_je p IC , '�-'� 0 -C------- 4f J/ J�X71 No. of compartments-well ---------- Liquid depth-- ------Capacity�j.*Z-0--o---- Disposal Field: Disfance-from::nearest weII41 'C Distance from foundation--------------------Distance to nearest lot line-.------ ---- '11 es---------------- -Length of each line------------------------------Width of tre"rich---- ---54.��---------- 6---Numberof 4 1 Type ofFfilfer material_- ---Depth of filter material__--__________________-Total'Iength------ --------------------------------- - .1 Seepage Pit: Distance,to nearest well----/M------Disfance from foundation-- ID Dist,grice tonearesf lot Numbe of pi s------- -------------k"ining material__-R0-C K----Size: 6"l-a-m---e_t__e__r---;-2'Y Dept h----/2------------ _I------- ... .... ... fn Cesspool: Distance4rom nearest well-----------------Distance from foundation.-------------------Lining material_______..____.______-_---___________a ' � j *AL 0 Size: Diarteter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity- --gals, Privy: Disfance from, nearest well------------- -----------------------------------Dilsfance from nearest building------------------------------- Di�sfance foinearest lot line-------------------------------'"----------- - ❑ ' ----- O Remodeling and/or nd/or re pa--i-r--in-g (Ucri-b--e--l--:------------------------------------------------------------------------------------)--------------------------------I -------------------------------------- - -------------------------------- - -- ------- ----- -- --- ----- --------------------------------------- - -- - ---- --------------------------------------------- -- ----------- ------- ------------------------T------------t--------f - -------------------------------------------------------------------- ------------------------------------------------- ---------------------------- ---------- I hereby certify that I Ave, repared This application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and Fu6s"6nd regulations-of the San Joaquin Local Health District. Q (Signed)----- --- --- ---- ----i I------------------------------------ tractor) -------(Owner and/or Con J, " UIA 0 AL �� -:--_ ------------------.___ -------------- .- - L -4 ---------------------- ---------- ......... (Plot plan, showingsize of.lo:�.11ocayfidnrof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 3. APPLICATION ACCEPTED0'_kTI 13 --------------------------------------------------------- DATE------- -= 6 REVIEWED ATE-------REVIEWED BY---------- ----------- - I - 4 - --------------------- ------------- ------------------------------ -------------- DATE------------------------- BUILDING PERMIT ISSUED ---------- -------- ------------- DATE----------------------------- ----------------i---------- r-H ------To---- Alterations and/or rec-ommehdaflons:.15�1-?=46X------- CT---- P-ER-7 - -------- ---------------------- -------------------------0)....).................. ------- ----------------------------------------------------- - -------------------------------------------------------------- ----------------------------------------------- - --------------- ----- -----------------------------------------------------------------------------------------------------------------------------**---------I---------- ------------------------------------------- ..... -- ---------- -------------------- •----------------------- --------------------------------------------------------------------------------- ---------- �— , �_ .. �� - - I . .— ------------ ----------- ----------- ------------ --- --------- 7 - ---- ------ - --------------------------------- -------- ------------------- --------------------------------- FINAL INSPECTION Y. ... ... Date-------- ------------- ----- --------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Evi- Es 9 R SED B.59 31M 3`63 F.F.CO.