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FPR OFFICE USE --------- Permit No. ...!- � _!._b ------------- ----- !CT( 0 '2 TION FOR SANITATION PERMIT-------------------------------------- -------- (Complete in Duplicate) __Date Issued ----------------- ___________ This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION--------- �j "-r- ------" f7smt-" _ Owner's Name----- - ----- ------------ --------------- Pho Phone ----•------------------------- a—-- -- ---- ------------ O Q __ _ ------ -------------------- ---------------------------------------------------------- Acid ress-------1- -;-----------��•---•--- r t ---------------- Phone-,?- _�vXX�4 Contractor's Name__C'f' -- •--- ----•`��-t�-----�-�-E-�--{---- - --- -�--- ---------------- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai4er Court ❑ Motel ❑ Other ❑ _ .. .. .,. _ :v 7 .� Number of living units:'__-_. Number of bedrooms _� Number of baths _/- Lot size Q-----. ----'. lr� --=-------------- Water Supply: Public system ar"Ic—ommunity system ❑ Private ❑ Depth to Water Table&a ft. t Character of soil to a depth of 3 feet: SandE] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe C]Hardpan Previous Application Made: [If yes,date-------- ------ -"--) No F1 New Construction: Yes E] No [j4/FHA/VA: Yes ❑ No El �t w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well------------- Distance from foundation-------------------Material---.---------------------------------------_-_.-. I S is Ta, No. of compartments--------- ---------------Size------•----------�--------- ---Liquid depth, Capacity... ��} - �yI.JDistance fromfoundation__I__v�_____._Distance to nearest lot line__!"_.___:. J t o5} 'e Distance from nearest well! �i `�T Width of trench. T��-...--"" ." Number of lines":�--�---- - ""'Depth ofLength ffilter�mlaterial_._ �-�-..-Total length_-.-__ ___: �-- -------- 4—A Type of filter materi t2- / A___.Distance to nearest lot ine., "� i S e Distance to nearest well.- - -----------Distance from oundation______. i p i ----.Size: Diameter ---------Depf62_ "._-------- "" ,• Dumber of its...�_________________Lining material__.__ ,�. Cesspool: Distance from nearest well_________________Distance from undation------------------- material"".-.___.._.___.-----_--_____._-_ ❑ .r Size;iDiameter--- Depth. = ------ --- -------- -- Liquid Capacity gals. O ----------------- tDistance from nearest buildin '`"' from nearest well ------------------------- 'Di --------------- Privy: Distance p -_-.-"__.._______________.____� 4� N � stance to nearest lot Eine-- ----- ----- - _:� ------------------------------- - ------------ - --- --=------ Remodeling and/or repairing (descrik�e�:"-- --------------- --- -- �------------------------ -------------------- - -- --_----- ----- - ---- -------------- __ __ _ ___------- ------------- ----------------------------- 1..�Y r .. ---------------------------____________-_ ______ _Y.____ - ------------------------------------------------------- y -3a..'♦y,:.: r * };. +wb Y-- ..ams... ✓ ----------------------------- ------------------------------ - ---------------------- I hereby certify that I havep pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,-and rules aP regulations of the San,Joaquin LocalHealthDistrict. "�".,, Lbi ----- -------- --------- [Signed).`� S-�P77L�Ah-K,ERVICM. (Title) l } -- ». . ---- Tit a ------ -- -------- ---- r � 0 2915 E.MinerAue,_�_k]Q Fa 3$41 t ------ Y� ------ I [Plot plan, showing size of lot, location of system in relation tos, et can be placed on reverse side}. i FOR DEPARTMENT USE ONLY �' APPLICATION ACCEPTED BY ` DATE Z �..�F? "-- --------------- - REVIEWED BY. -------------------------- I. ----------------------- DATE ------------- -------------------------------------------------- - BUILDINGPERMIT ISSUED------------ ---------- _- ------------------------------------- DATE------------------------ -------------------------------- Alterations and/or recommendations:------- -- -------------- ----------------------•----••--------------•---------------------------------------------- _ - ----- -- ------------------------------------------------------------------- ------•------------------------------------------------------- : ------------------------------------------------- "~ - ----------- - - - ------------------- ell ----------I--------------------- ----------------------- ------------------ ---------------------------- ------- -------- -------- --------------------------- I f ell-- FINAL INSPECTION BY:..------ ------------------------------ ---- Date--- - ---- ---------"---------- ----------- :----•---- F SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 205 West 9th Street 1101 E.Hazelton Ave. 300 West Oak Street 124 5 Y Stockton,California Lodi,California Manteca,California Tracy,California