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-------- ------------------------ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------- ---------------- (Complete in Duplicate) - Expiresbate Issued ---------- ---------- - --� -------------� -- This Permit 1 Year From Date Issued 2Q Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe work herein described. _. T,his-applicatiqh is made in,compliancewith County Ordinance No. 549. JOB ADDRESS AND LO" CATfO Owner's Name________- - i ! _ J_�'_L_-• _� j � -------- Phone--------------------------- Address----------------- ��' 7r�Q ----------••------_1_. �1 -------- -LJ_I F' ; ♦. 1 Contractor's Name _I l h A _ __---------(PARap -------R-W _ © ""E_ �__R I Ph o i. ❑ ❑ Other c Instaifation will serve: Residence ❑ Apac.tment House ❑ Commercial �ralle4 Court Motel ❑ Number omits: ---1--- Number of ed ms ...... Number of baths ._i_,Lot size Water Supply: Public system ❑ Community Sysm.❑i Private [Depth to Water Table Character of�soil to a depth of 3 feet: Sand Gr*avel❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [] Hardpan ❑ Previous Application Made: {If yes,date � � FHA/VA. No .0 New Construction: Yes o Yes ❑ No�' TYPE OF INSTALLATI N ND-SPECIFICATIONS: (No septicktank or cesspool-peimitte=f public sewer is availab e:,within 200 feet.) A., Septic ` oundation____ Q� .Materi I____. O"( � No. cf compartments.'.'---..--- ompartments..k__- ��- - Size----3 -_ "_ .__.Li uid de th__. / ' Q '� Tank: Distance�ce 'from nearest welly �____Distance ffDR1 f q p -� :Capauty...__�-""._�-" l A Dis oral Field:. Distance 'Numbe'r-,oflines earest ell—SO rDes��}a fC ofreo� nn ��l,y Widt0 to n'are_st lot P r �~x on ----------------- / ----- 1 - Depth of filter mater a"I____-f s "-.-.""Total of trench._! �i"��_" _.-.""_-."-" - - �} Type o filter material_-- - -�._-- ) �� length__ _ ------ - -_ ❑ Number of..pits---- ----------------Lining.material--------------------- Size: DiamEter_ ( De = Seepage Pit: Distance fo nearest well________________ Distance from foundafion___ --____._ lineI W- ..__..Distance to n`parest-lot __.-___.___-__=$ , Cess ool: Distance from`nearest well_______________"_Distance from foundation_..._. 3_.._..Linin materia!__n p � g ( ---------------- ----- ❑ Size: Diameter--- '--------------------- ------Depth- ------ ------ Liqui Capacity rce--------------------- gals. it Privy: Distance from nearest well---------------____________________ Distga�nce ft6m-nearest building__- " --------------------- ❑ Distance to nearest lot line.___________________ ._: N---------------------- -- -I----------------------------- Remodelingand/or repairing describe - " "_-"-- -- - __-- - /yJ -----/V70 , ----------B—F---- I��-D-------Vlf� _I_`['N�1= __R T _= __ x-Ac1� o iD�__ ------ jq ----- -------------- ..--! --------------- '�` ------------------ -- --- -- State laws and rules and re ul 'i Il pp " " F !___ n " n Is ! hereby certif that I have prepared �hls a� lication and that the work will be done In accordance wtth!San Joaquin County ordinances, g a ions of Ih San Joaquin Local Health District. �.. - ; --- ------------ -- ----------------------- �J r Contract __Own�'�i'td/o —' or) Y' Title) 8 . (Plot plan, showing ze of lot, location of system in relation to wells, buildings, etc., can belaaceed' reverse]side). :k FOR"DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _R� = `---- ---------------------------------------- DATE------ _. ."_ —------------- REVIEWED BY --------------------------------------- - �"- DATE-------------------- BUILDING PERMITISSUED---------------------------- ----- �--- - - l ----- �M ----- -�------�- -�-----•---- • ----------------------------- DANE---------------------�-Alterations and/orrecommendations-__. - - } ,. :-------4--- _ H- 9---! tom` -A r - 7 jk -- -------------------------------- I --- ---- --------------- ---- --------------•---- .. --------- ----- FINAL INSPECTIO . . . ------- ------- Date......... I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 4j, Lodi,California Manteca,California Tracy,California r, F.P.C❑.