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Permit Na. __ ____APPLICATION FOR SANITATION PER (Complete in Duplicate) Date Issued ----Y1191-dT_ 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 incompliance with County Ordinan'cb , 549 ----------- JOB ADDRESS:AND --------W_ -----7----------- --- -- -- ------ ---------------------------------------------------------------------- Vir - -------- ------------- Phone--------------- k_t. I . -- ---------- --Owner s Name__ ----------- Address-------------------- ----- ----2W LAPM------------ ---------------- ------------------m----------------------------------------------------- T ------- Contractor's Name --------- - - - - ------------------------------------------------------------------------------------------- Phone----1--------------------- Installation will serve: Residence Apartment House E] Commercia.1,E] Trailer Court El Motel 11 Other 1:1 X --- ------------ ---------------- Number of living units. Number of bedrooms -2--_'Number of baths 'Lot size .111 4f A Water Supply. ' Public sys s, ern 541�Acommun'ify system'El Private'E]! Depth to'Wate' r Table'_-W. 3 2 49 4 - liardp Character of soil to a depth of 3 feet: i Sand E] Gravel El Sandy Loam E] Clay Loam E] Clay E] Adobe%?*I- an [I Previous Application Made. Yes.E] No *0 New Construction:. Yes:,�N8 r-1 FHA/VA-.,Yes W?O' No D TYPE OF INSTALLATIONk AND SPECIFICATIONS:I (No septic tank or'c sspoolkperr�ifted if public sewer is available wifh�iri 200_fee+.)_ -V- .1 . 1 ` �_p Tank: taf eT_ Distance from foundaton----/0"_-."_.Maferia _41 ---------- Se tic S w No. of:dompartments------*12,-------- Si,e___Z_'_9r_j*------X_f(,O.Li�uid dep.fh------- -------Capacity-----It._ Disposal Field: Distance from nearest well- _-�.......�Distance from foundation-----/------�,_'.Distance to nearest lot line--.440------ ---------- ---- Number of. lin's J -------- Length of-each line---- 4------Width of french.__.24(l/-------`______-_-. pe '41 _ ___Depth 1 "It"_.-Total length------1147AO-10 . ........... of filter maferlalj,�;i4 - _- material____. ------------- Ty - of fiIfer,.Maferial____" . ___ __ 1� go", . 14 11 .1 • Seepage Pit: Disfan!!e to nearest'well'---I'- Distance f�o�ma,fou ati6n_'7_7 1 ,f�n t -------------- 4 pe to nearest I materia _ Size: Diameter_ I --------- ----Depth ----------------- Numbeor of pits------ Lining S Cesspool: Disfan,,Ie from nea'r'est well-4 --------------Distancefrom foundation - ------------------Lining material____--__________-____________--....Size-. Diameter-----'-----------=----------I- Depth--------------- -----------------Liquid Capacity-------__---------------gals. -4- Privy: Distance from n'earesf well__-_-._ ------ -- - --------------------- isfance from nearest. building_:_____________________.--------------- ❑ A-4. 'Distante to nearest lot-line-------------------------- --------- --- ---------------------- ---------------------------------------I-------- Remodeling and' scribe):. -- -----------------•-----..-._...------------- P/or repaling (describe)..-----•- - 4. , - ------------ --------------------Z----------I --------------------------I------ ------------------- -----------------------------------------------------------I-------- -------------------------------- �II --------------------------------------- ------------------------ ------------------- ----------_---------- --------------- ---------------------------------------------------------7-r------------------ ---------- -I-------------------------------------------------------------------------- ----- ------------ ------------------ ------------ -------------------------- ------------------------------------------------------ I hereby certify that,,I have prepared this applicath;in and-that e work wil[be done in accordance with San Joaquin County ordinances, S+:fe laws. an" rules and regujations of the San Joaquin Local Health District. L -- -------- ---- ----------- ----------------------- Contractor) ------------- I------ -- - (Signed)_ By:------------------------- .... ---------_-------=----------- itle)---------;W_ 4V_4!V-f�_ ---- ---------------- {Plot ----------------- ------(Ti (Plot plan, showing size of of, locas" ' . A t Von of system in to wells, buildings, etc., can be placed on revers side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------------- DATE---------------------------t --------------- REVIEWED BY------------------0--------------- - -------- ----------------------------- DATE----------- ------- ---------------- ----------------------- ----- ------------------------------------------- AT -------------------- BUILDING PERMIT ISSU11D----------- --- ---j--------------------------------------------- -------------------- D --------------------- Alterations and/or recommendations ---V------------------------------- ----------_----------- ------------------ ------------I-------------- ---- -------- -- ----------------- ---------I------I---------------------•I------------ ------------------------------- ------------------------------ --------------I------------------ -------- ----------------------------------------------- ----------------------------------------------------------------- ----------------------------- --------------------------------------------------------------------------- -------------------------------------------- ------------------- -------- 7'.1----------------------- t----------------------------------------------------------------------------------------- 2— f -Date------- ---------- ----------------------- --INSPECTION B; ... . FINAL INSPE SAN JOAQUIN LOCAL-HEALTH DISTRICT 'A 130 South American street 300 West Oak Street132Street`SycamoreStrt k -1 k 814 North "C" Street ' *1 \ % Stockton, California : Lodi, California Manteca, California- Tracy, California ES-9-2M Reyiseci 1."57 F.P.CO.