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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _`�Y7 0 Local Health District for a permit to construct and install th �work herein described. Application is hereby made to the San Joaquini This application is made in compliance''with County_Ordinance,No..549.�',I_� z'! -: --r- F-- .. A SF Stt-�-`u-------------- = - - ---------------------------------------- JOB ADDRESS AND LOCATION-----I A)------- - c . c ,•a.a _Owner s Name ---�t17,-------�•-----��- • ray ------�-_- --_---em---,--•-„------•--_-----"- ---�-=-«-".--l �L-"----_-C-- - ------------------------------------ k- ---------- -------"-------•--- ¢ �Cl sr -Y' - _ , ----•------------------------------------------------ Address ------q-�-�----•---- Phone.. `- Contractor's Name-----15-`-�JAJQ—&---------___., ------= TrailerCourt ❑ Motel ❑ Other ❑ Installation will serve: Residence Apa'rtme t House ❑ Commercial ❑ i -I-.. �F < ZI__ Number of bedrooms Number of baths � _ 1�ot size . X_..__4 -------------------------------- Number of living units: _ R ` Water Supply: Public rystem "' Community system El' Private ❑ Depth to Water Ta61e' `.ft L. 1 i Adobe Hardpan Character of"so"il'to-a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ I� ❑ I KL Previous Application Made: Yes ElNo ® New Construction: Yes I& No E] FHA/VA.. Yes ❑ - No TYPE' OF INSTALLATION AND SPECIFICATIONS:- - p p' 'i•ted if.p' r is available within 200 feet.) ; [No septic tank or'cesspool ublid sewer f Septic Tank: Distance from nearest well --------Dist6nc�e from foundation____._____.________.Materia4__.____r____ ____- I. Liquicl depth-.�---- -_..-- Capacity No, of compartments----------"- --'--- -"---Size------•-------- ------•---=-- ------------------•---- ` i. . > r Disposal Field: Distance from nearest we111nA__+:�2.R�.:Distance from foundation---7 _Q_-��__Distante }o,nearest lot Number of lines-- ---I------------------l ---r Length of:eats, line---- 4,Q_`_ i`" ------Width of trech ---z- i--------------------- \ . Type of-filter material.... 'c_S�c - 17epth`of"filter mater al___.' {_ __°_.____Total length-' 4 ------•--:----•----- ' - ' ' `_--'Distance•to nearest lot line____�_r_---- Seepage Pit: Distance�to-nearest well4 _ w - - _Distance from .foundation.__ .� Number of pits"-------1---------------Lining material----Vi'Qz,.� --.Size:Diameter_-- • �-�� -------Depth__..- 5-�-- �r ` { Cesspool: Distance f omInearest well--____-_--°____-Distance from foundation.______.___._.__,_.Lining materiel__..____..._______,._________________ ❑ Size: Diameter ------------------ L`------Depth--------------------------------------------V--------Liquid Capacity--------------------------- -9als. � f Priv - Distance from nearest well_____.�__.____°---------------------------- -"'"Distance-from nearest building_�_.__..___________..------"_-- ❑ ""` -----------------------------•----------------- - - 'Distance-to nearest !ot line---------- ---- ----=-=-- - 1 Remodeling and/or repairing (describe):___a_, A--------4 -i---- -c- ""`R' - 1 .` ..._,S•�-S ----�t------- --- - - , -:---------------------- -----•------- ----------------------- (Z -, - �; t - ---- ---- - ` ' - _ __--"------- ----- --------- ------- -------- -____-___-__.______._-_-_--:-__i______._______.____..__«.__.______________________._______.____.______.____._______________._..__._ ---------- I hereby-certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ces, St laws, and rules and reguiati6ins of:the San.Joaquin Local Health District { ------------------------------------------------ or ordinances, (Sig �ned �� ' ---------------- t [Owner end/or Contractor) -- ------ Sze of o locatio -------------- -------------------------------- By; {Title)- .------_--------------- - ------------------ ------ n`of s stem=in,relation to wells;buildings, etc., can be placed on reverse side). (Plot plan, showing s� Y� 1 . ` FOR DEPARTMENT USE ONLY I` { -- —` DATE--- -'"+ ' 3 Y E---------------------- APPLICATION ACCEPTED BY-:-_°_C-_,,__ .t: u _- DATE----------- REVIEWEDBY------------------------------------------------------------------ ----------------- ------- BUILDING PERMIT 155UED--=------------------------------------------------------------------------------------------- - ------ DATE------------------------------- - r ._ ' , Ism K Alterations and/or recommendations:____42.7_$41.1------------------i----� �' ------•_..... 'L` -L- -------------- ----. FINAL INSPECTIONIBY:_:._-_C----t-Ca =4�----`.--------- SAN JOAQUIN LOCAL HEALTH DISTRICT North "C" Street 81�} 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2KI Revises 1-57 F.P.CO.