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-------------- K vrnLt 3�� - - - - _. - APPI_ICATI4N FOR SANITATION PERMIT Permit No. r... __ (Complete in Duplicate) -.-- . This Permit Ex fres l Year From Date Issued ` �W ~ ba to Issued -_`----- �{ Application is hereby made to the Son Joaquin Local Healfh District for a permit to construct and install the work herein descbed. This application is made in compliance wit County Ordinance No. 549: 4-tr Gi,� fs- # er - ', i , 10B ADDRESS AN CATION:_ - ---- Z " Owner's Name_ 4. LLp!-� .c ---•--- / -----------------------•-- ---------------- Z� Address ------------ _ :_ Phone__._'-------•------•---------... �---- - --- -------- k. - --------•------ --..._ ---------- Contractor's Name------- ••-------•------------------•-----------•-------------------- 114 ---- . -: Installation will serve: Residence Phone---•- L�' P+partment House ❑ Commercial ❑ Trailer 'Court Motel ❑ Other ❑ - Number of living units: __/--- ber of bedrooms _-3-- Number of baths --,1%ot�.size ,l_ �y Wafer' Supply: Publics stem ,-- f ----------- Community _ I Y ms stem I Y ❑ Private ❑ 'Depth to Water Table ft. Character of soil to a depth of 3 feet:f Sand ❑ Gravel ❑ Sa -�"- . , ` y Loam ❑ Clay Loam � `' Y ❑ Adobe Hardpan ❑ Previous Application Made: (I#Yes,dpte--- 4:`-_---_----1 No L7d New Construction: Yes ❑- , ` TYPE OF INSTALLATION AND SPECIFICATIONS: I��NO ❑ FHA/VA: Yes �No ❑ (No septic tank or cesspool permitted if.public sewer_is,ayailable within 200 feet.) Septic nk: Distance from nearesfi:well____ "`� "'""" � _ Distande from {oundation__-_J- ------.Materia!_8CfY!C e— No. of compartme ..r 'L�_--- --.-Size =::.,_ - --- -- € 6 p Liquid depth-_ % ........Ca acit _ _ Dis osal eld: _�---_-Distance to nearest Y?1� --------- ER' p Distance from nearest well-_�"--.pistanceyfrom foundation__ Number of lines_____- s lot line' ---------- - - _ Length of each line--:7-p-�_-�g4'------�Ilidth of trench_---K_-�/--__ _ Type.of filter materiaL ��_ro4AFpepth?of filter material____ 0 '---------- Total length---lam Si Seepa it':. Distance to nearest.well Distane from foundation--- p ......Distance to Weare �7/ Number of pits.-- --" -~L"inin nearest lot i�ne---x---------- 1 Size:^Diameter /- / Cess ool: - --3�----- ---___Depth��S`__lnc�____ p Distance from nea�st well_________________Distance from foundation Size, material___._._--_--- / ❑ Size: Diameter_____ _ _________ ------------ Depth-------------- ------ - Liquid Capacity = ------------O ------------ -- Privy: Distance from nearest.wel!-------------------------- gals. S El Distance to nearest=lot line - -----Distance from 'nearest earest building---------------------------------------- --------------------------------------- Remodeling and/or repairing (describe).----_-- _-- ------------ ,r� ...... ` ---------•-- _ �- -•--••------•-------•------- } ., - - - ---- ----- --------- ----- ------ ---- 1 I hereby certify that I have prepaed this application and that the work will be done in accordance with San Joaquin t ordinances. State laws, and-rules and ` ulations of the San Joaquin_Local Health Distract. quln County ' (Signed)--:----------------- !� l (Owner and/or Contractor) Plot Ian, showingsize o o , location osfiemW:ireati ----- Title _ ( } I on o wells, buildings, etc., can be placed on reverse side). _n. l + n -- s 'y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____- .- s REVIEWEDBY------ --------- ------------------------------------------------------ ----------- ----- � - -- - - - --- UILDING PERMIT ISSUED------- DATE---- -------- ----- ------------------------------------------- Alterations and/or recommendations:r-1---;-------�.--------- "` ------ DATE z�`-+a 5`� _ ------ ------------------------------------- ------- ------ •- --- ---•- - ---------------- r _ - —. t - :---rte.._.4�.!_s_ Q.c�. ,n ---- G y : : _ --------------- -- --- - -- { .��_ �� - --------------------- ------------ FINAL INSPECTION BY:.__-.-_---- -- • ' r'G'z; "a? : ` < ��►'--------------------------- Date r �- �, rjj( `SAN JOAQUIN LOCAL HEALTH DISTRICT ? 760i' :Hazellon Ave. ( � �x { 300 West Oak Street 124'S�more Street - f � Stockton,California Lodi,California 205 West 9th Street Manteca,California ¢s 4 aev"sco a-ss 3M 3_'63 F.P.co. Tracy,California E