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FOR OFFICE USE: hx�—,q � --- -------------- ----- .I ----- ------------- - Permit No. --------------------- ----------- -- -------------- ---- APPLICATION FQR,SANITATION PERMIT G4 (Complete in Duplicate) Date Issued ---------- __ .._ This Permit Expires 1 Year From Date Issued -fK " Application is hereby made to the San Joaquin Local Health District for a ermitJo-construct-anzl"�iif�fa`al/ll��a work rein described. This application is made.in � iance with Count Ordinance No. 549. y S:"!"6i5 fit 1,4LZ�LOIV Se r - -- - -- b- JOB ADDRESS AND LOC TION- - -Se�_�-�� __ 1✓�C—D��-�- -- �------ -�-r�-�------��d---�• -- ��` -��-�� Owner's Nara- :--------��`_VU_AR D�� Q �- - Phone �{ Address-------------R- --"`----3 -----13D_�-------I-lilt)----I------ -�_Clq_�.�hL-..'----------------------- 0 Contractor's Name--- 1 - ` Phone Installation will serve-V Residence ❑ Apartment House 11Commer'cial [vYTrailer Court [I Motel ❑ Other [:1 Number of living units: -------- Number of bedrooms _.__-__ Number of baths -_ Lot size _1 Water Supply: Public system ❑ Community system ❑ Private' 2-�Depth.to Water Table ft. t Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam_❑ i Clay Loam [Clay ❑ Adobe ❑ Hardpan t ;ICs �-1 . .� - pp - I b4� ew `'. -1ucti4 Yes �Ilo ❑ ;•FHA/VA: Yes ❑ No Previous Application AND SPECIFICATIONS' l No N � � � � t TYPE OF INS (No septic ttank,or cesspool permitted if public sewers available within feet.) ,c.....�.�.- a Septic Tank: Distance from nearest well___S �yDistance,from%urtd6fion- _� _ _ /mob Q Mat real-�_CQ - -CR�T t No. of compartments-. * � �i�uid depth-- � ... _ Capacity----- 0- 1-- from found0'jQn____/j9._____.._. stance;fo nearest lot line___Disposal Field: Distance from nearest well _.�Q__._Distance INumber of lines_--.----- 0 -- 2_----------------Length of each line_ - '-5 ----Width of french---- !f-_ _____...�_________ v Type of filter material--R-OC ---•Depth offilter materia!_____] w-- -_---Total._ length_-_________- I � t .. Seepage it: Distance to nearest well____)_Q-©_.___Distance from' found" 'E� _.__.___ 'stance to nearest lot '" /.d---Depth - � Number of " its--_-__-- --._ Lininmaterial--- �.CK...Size. Diameter. ---_ ---- p ,��---------------------- P �- - � g t # TlZN• �+ . Cesspool: Distance from nearest welh.fi_-__.____.__Distance from foundation __.---.Lining material--------------_________--__._____- Size! Diameter - - Depth :--w_- :. . �- iquici'Capacity gals. rri Privy: Distance from nearest well---------------------------------i -:------------Distance from nearest building----�-'----- --------- -------. ❑ Distance to nearest lot line]----- --------------------- ---------------- --------------------------------------------------- f 1 Remodelingand/or repairing (describe):--------- :- -----------"--------------------------------------------------------------------•------------------------------------------------------• 3 --- --------------------------------------------- ------- ------- -----------------DJ ------(-I----------- ---------- - ----- VIO 1.1-i **,a+I Il I --------------------------- ------------------;------------------------------------------------------------------------- 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., p I ; 11' 11� t" 0 ------ ------------------------------------------------------- _ ____________ _____ _{Owner and/or Contractor) ► [Signed)_ ---------------- ------� BY� --y- -=`- - - - ------------- ------- ------------------------------------(Title)-- ---- - - -- ------------- - t--(Plot-plan, showing size of lot;location-of-system in relation.-to wells,Tbuildings,-etc.,_can._be_placed.on_reverse side).- , . I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY p-=----- ----------------------------------------------------------- DATE----- --------------------- REVIEWED BY.----------------------- -._ ' ------------------- -------------------------------- --- TE ` BUILDING PERMIT ISSUED----------'- ----- - 1fQT <.rl-t Rl = � 5 D TE-------------------------------------------------------------- Alterationsand/pr,fesommendations------------------ ------------------------ ---------------------------------------- ----------•------------------------ -------------------------------------- �= ------ A---------C SQl -.......f.><ly T1 f -AQP�� -- r oN JL aft %-Vl Z44 ki - ��. .• - -- - - � - - • ilii� 'T��----� - -- I_-,.T: ---)9-Y,DEE -r_5_------.119_N_a-.._W(-rH-------�'�R, ---------------- ------------------------ --------- f 6� � FINAL INSPECTION BY:------ -- - - -- --- --- ------ - Date---- - ----- ---------�1-�_r- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California = a-hp Manteca,California Tracy,California i F.P.CO.