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FOR OFFICE USE;. -------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- ---..---- (Complete-in Duplicate) _. ___._............ ..... .........._�._-__ ._....- - -- This_Permit_Ex ices 1_Y_ear_IFrom_Date_Issued_..,,_ _ ... . .. _ .Date Issued �_ Application is hereby made to the San Joaquin.Local Health District for a permit to construct and install the work herein described. This application is made in complian a with County Ordinance No. 549. "" �� 09 JOB ADDRESS AND LOCATIO4_F-____CiV_------- 1_ _t+�fl :f _.-.' _- -_._R�- - ...._-_-...-• S � Owner's Name-------. -- �f �f- J.+ ,�V------------------ ---- , ----------------------------- Phone------------------------------------ Address--------------- --'-- -:----- } ------ . - --- # Contractor's Name__t9. 1Aj1Z- � A.._'_.0 2n!_nf.ER f MPQ ' ----.- Phone........---�------------------- Installation will serve: Residence [0"Apartment House ❑ Commercial,❑ Trailer Court ❑ Motel ❑ Other'' ❑ • 9 ---i b-�, I - �._ Lot size � `�._ `:: � ------=- a Number of livor units: __� Number of bedrooms _,.,�_ Number of�baths._ Water Supply: Public s stem Communtt s stem ❑ Private e th tot Water Table fir 1 { Character of soil to a de th of 3 feet- Sand G-ravel Sand Loarri, Cla Loam Cla Adobe Hardpan P ❑ ❑ Y Y ❑. Y ❑ i ❑'z. ❑ i ' TYPE OF INSTALLATION -AND SPECIE{GATlONS: ❑ F��. �'4No ❑ � Previous Application Made: (lf yes,date_.........-,------- 1 !No New Corfstruction: Yes . a HA/V ` Yes( r - _- � is nce from faun' anon___-_- Mate ia#__- . - {No septiic dank or cesspool permit etl-if public sewer Is available within 200 feet.) 4 # Septic Ta k: 4 Distance from nearest well.---$ -J-Difa � .-.__-.. -5 l - -.--.._._. U� No: of eompartments:__-...____..__-.-..is Slze._-_... _ _ _.Liquid depth_.. ��_s__..Capacity....-� . Disposeld: r Distance from nearest weh___S. ...___._Distance from foundation--------------------Distance to nearest lot line................. ! Number of lines--___-_--S --...________Length of each Iin"W_ ------------Width of trench_...__._ ---.-_-- ---- Type of filter �aterial__RvC_--.Depth of filter material-_!-j'7__.'S_..._.-Total length___..__._aQ ___j______.___.___ v Number„bf its:- . ...................L-i-....... foundation-------------------to from fo�t�S�ze.Diameter.____.._._..-__..._._Depth-------_...-_.----------_------_. p 9 - Cesspool: SDistance`fiom nearest we'lft' Distance from foundation-.-_------------ - ii t - Lining material_ ______--._.-------.---------_.----. jEl 'Size: Diameter- -- --------- ----i?1i-----------'.De th------------------ Liquid Capacity-.. gals . Privy: 'DistanceH om nearest well!','_l_-.......I----..-.--..__-------- -- ----Distance from nearest buildin, ❑ i ,Distance?to nearest lot line- .....= '- --------'----------- `' ----------- ----- ----------------------- ._;W ._ ----- ------- Remodeling and/or rriepairing (describe]:...._Fr ,... A- i �, 1 -- ---------------i ----------------------------------------- --------------------------------------'--: t ` = '-•------ `-----------------------------------•-------------------------- ----------------- ------------- ------------------ �. ---------- ------------ - --------- -------- •--------------- ------------X = - - I hereby certify that I have prepared.this application and that the work will be done in accordance with San Joaquin County ordinances, State law , n& ' ales and regulations of`theiSan Joaquin katal Health District. (Signed) Y'.M1_+,�} k _- [Owner and/or Contractor] BY--------------- ------------------------------ ------------ v (Title] (Plot plan, shovrings size .of lot, location of systernjrt relaf2in4o wells, buildings, etc., can be placed on reverse side). __FOR DEPARTMENT,-U:§E ONLY APPLICATION ACCEPTED BY_ " ., kl ---------------:" ----------------- DATE----- - ' - ------------ i ---- - REVIEWED 13Y_ r ��__.._ - ---------- -•-- ------------------------------ ---- ---, ----- x DATE--- -• Y � BUILDING PERMIT ISSUED-------- ------ ---pp ,..._ -r -- - ----------------- - - -•--------- DATE- ----- ------�------------- ------------------------ Alterations and or recommendations:...._-_f r�.. w --......ANI -----F&KM'-._....0r-�_..-..-----'` -`-Fi- --------------------------- 1 :. G - �r�► .-`m__ ,--r;9N- or:__1.n � _� � U ._._[ _--------------- ---- !l s P cT>~ . _.`_C t.,1'1=__!1rv!-[ ��►� l� P -------- �. _Q-------- _ ---------- ---------------- --::---- - / r Pi�tT A__':_-MfJ�----t 0.- flit- �;RV .__.p�k_--_-.---------- •----------��^EA�--- -.-;-3�. . . . -tea-- - - - � - - - -- - --� p.... 3ir3G1KF�- gip. - t �Tai GH �It ----------------------- . - FINAL`!"NSP 1Ais . . -- --- Date--- -- 1 `-� ------ -. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California todi. California Manteca,California '.Tracy,California E.H.9 2M 1.67 Vanguard Press r _