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Permit No. ------ t. <br />PERMIT <br />5 APPLICATION FOR�SANITATION <br />Com in P <br />0 uplicate) Date issued __::Fj -1 <br />o - -- ------------- <br />42-10 -0 - <br />�Xil\v 6 <br />e <br />and install +he work Herein described. <br />ricf for a permit to construct <br />Is hereby <br />made t 8 San.joaquin Local H. alth Dist <br />Application �y.'�n No. 549. <br />de in rompliance witH County Ordin nce <br />,\This application 'IS ma I- Of ------------- <br />JOB ADDRESS <br />—A <br />Cyan <br />s Name <br />-------------------------------- ----- ----- <br />--------- ------- <br />AN LOCATIO <br />Phone - <br />le <br />---- c -7&O ;Lt- <br />--- - ---------- -----_------- ---- - ----------------- - <br />Phone <br />-- -------- <br />'s Name-_____- .- --- ----- - ­ - - 4Court 17 otel Other El <br />wateripuppi <br />Chara. Of <br />Previous AllpPlic <br />TYPE OF INS1 <br />(No sep <br />4 eiptic Tank: <br />Dki,!p ssa• <br />ield: <br />S,epa Nit-, <br />Cesspool: <br />0 <br />Privy' <br />I] <br />I Remodel <br />Seserve:Residence Ap ment House El CO Li ercial r8 '_ r ----------------- <br />Lot size - ----- '�%I_ <br />'its: Number of bedrooms Number of baths <br />of living un -- ----- �Nu afer Table <br />Public system F1, Comurimity system E] Privatex, Depth to W <br />.140 a depth of 3 feet: Sand 0 GraveEl Sandy Loam 0 Clay Loam El Clay [] Adobe, Hardpan C1 <br />New 'v Construction: Yes 3d No E] FHA/VA: Yes E] N OA <br />at Made: Yes 0 No , Constru <br />4 <br />ALL,kTION AND SPECIFICATIONS: <br />tic tan ,or -cesspool permitted if public sewer is available within 200 fee <br />---- Distance from foundation ------------------- Maferial --------------- ­­ ----------------------------- <br />Diitj ce from nearest Well --------- --- ------------ Capacity— -------------------- <br />D',', <br />-•--------Liquid ,dep�h ---------- <br />---- ------------------ <br />r ments --------------------------- Size <br />o nearest lot line____.___.______,. <br />Distance t <br />Disia�,c :from nearest well ------------------ Distance from foundation Width of trench <br />of each line ----------------- ------------ <br />u --- Length <br />urnbc"r lines --- ---------------------------- ------- <br />I of filter material____------------ Total length ------------------------------ ---- <br />T pe of filter ft4t.,erial ------------------------- Depth <br />f nclati nearest �fil on _47---Disiance to nei <br />i cell�Aearest ------------ Diste ..? '� <br />D i ts o Size: Diameter_ -------Depth_ <br />— ------- Depth <br />Num e r ----- Linin material-----:--_------------------ <br />4-66ndation ------------- L' i �Rfn–g <br />f wrest well------- Distance from <br />Disfancq .1,,om r Liquid Capacity- � --------------------------- 9815. <br />"Miter------' I �_'_____Depth -------------- ------------------------------------- <br />S�Ze: �a---------- <br />D'' <br />building---------------------------------------- <br />om a <br />nearest building. <br />Disian om B a est well----- r - ----------- ----------------------- ------- -------- <br />- - Irp, ------ stanca, ` <br />lot line--------------- ------------ -------------- <br />Distan' <br />------------- <br />,n4/9r re' airy(describe):--- -------------------------------------- ---------- ------- <br />------------------------ -------------- --------- - --------- --------- ----- ----•-----•----- <br />- <br />------- <br />r` <br />- ---- -------------------------------- I --------------------------------------- <br />------------------- <br />------------ i ------------------------------------ I --------------------- -------------------------- <br />--------------------- -<------ -------- - -------- <br />I - ----------- --------------------------------------------- : -------- ------------------------ --------------------------- -- <br />----- ------ ------ -------- 1 11 - 15� -d-orfei in <br />--------------------- I- prepared this applicatio and tha the work-wi accordance with San Joaquin County <br />I hereby cerfifyk.4hat.-Thave prep <br />ordinances, S A Ia..w d rule )of the an Jo in Local Heal District. <br />(OwpQ; d/or Contrac <br />.. . ... .. <br />-------------- <br />(Signed ti - - ----- ............... ....... <br />— ----------------------------------- (T; <br />zi." <br />�y­ ---- -- - n o wells, buildings, etc., can be paced on r arse e) <br />(Plot plah 0 IT-0catio stem in. a i <br />FOR DEPARTMENT USE ONLY <br />DATE ---------------fig (AA -------- ---------------------- <br />A PUCATI0' ACCEPTED BY ------------------- -- ----------------- --- ------ ----------------- <br />REVIEWED By --- ----------------------------- ------------- DATE -------)-:rte ---------------------------------------------- <br />--------------------------------------------- DATE -------------- ---------------------------------------------- <br />tUILDINGPERMIT ISSUED ------------------------ I ----- --- ------------------ -------------- ------------------------ ------------ ------------ <br />---------------------- ----- <br />Alterations and/or recommendatons------------------------------- ------I ------ ------- ----------------------------------_----------------I------------------------- <br />----- <br />---------------- <br />--------------- : ------------- I ------ <br />------- -- ------------------------------- <br />..................... -------------------- ----- -------- <br />----------------------------- <br />--------- <br />---------------- ------------ ----- ---- -- - - ----- <br />9� . _ L" _* ------------------------------------------- <br />----------------------- C__�/ ------------ ----------------- ----------- -------- -- --- ---- -- ---- --- ---- -------- <br />-------------------------------- I --------------- ------ X --- --- --------- <br />------------------------- --------------------------- <br />--- - --------------------------- ---------------- <br />Date_ ---- <br />FINAL INSPECTION BY:.:______--------- - ------------------------------------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />i 2 Sycamore Street $14 North. "C" Street <br />130 South American Street Soo West Oak Street 13 Tracy, California <br />Stockton, California <br />Lodi, California Manteca, California <br />ES -4--2M Revised 1.57 F.PCO. <br />