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roll cel-J-1ZL ---------------------------- -------------------------- ; --------------------____-----________ _______________ APPLICATION FOR SANITATION PERMIT Permit, No. Com letein Du Iicate i j7 (: P P ) ----------- This Permit Expires 1 Year From 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 compliance with County Ordinance No. 54-9. -. _rte - _•.r .- „ .•,�,,,�,� � 11E JOB ADDRESS�AND LOCATIOiJ_----------'--R_1 -----:R --- -----,�, ;_.1/1I _ 5 �}Loeti( FRi�LT7� .----RD Owner's Name--------- nuj>�------- M_ ` a I �------------------ - - ------------------------ h=------ --rPhone = 2Address ----=-------t--------�-$0 N M-------F ------------- ---._-:_..t q Contractor's Name .f 14LR == = Phone.1 ----------------•----- r Installation will serveResidence ❑ Apartment House ❑ Commercial ❑ Trailer + •` Motel ❑;Otherdr I ❑ Number of livingunits: -1----- Number of. bedrooms _ Num,ber�of-baths __/ -------------------- IL Water 1__. _ Lot size--__- __- Water Supply: PublicK Ac system [] Community¢system�❑ItPrivate [�6epth to Water Table 3p_ ft Character of soil to a depth of 3 feet: Sand [[Gravel ❑ =Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ _ revious_Ap.pfica-ficn_Made (If�yes„datefg-r�_-ll!?__--_). -_N_o. € New Construction: Yes Rlo ❑fi FHA/VA:_Yes_f - NoP— TYPE OF INSTALLATIONjAND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within`:200 feet.) t 0O ) Septic ank: Distant nfrom nre"es well Pl,' ___Diisstanw •fro 2fourida"tion___-. No, of�corh artments__ �--•�,w.#Size_ S Li wdtde-th._._u T �� ___._.Distance to nearest lot line-5_ _i� Capacity- Di Field: 1P 'Vi from nearest_well .�]-� .Dist - e fr'b f rr� on________. __._ Nu�nbof Imes____-------- Width Width of trench---- _ r=---' -- r Type of filter mati=riaF'"' 1 C} [}epthof'filter material__` Tota# length-____._______ . -__6- p g tante. to nearest well_____. -__Distance from foundation�4w_� ltR . _ _____._.Distance to nearest lot line__.______-..____ ee❑a a Pit: Nlur berjof; pits---------------------Lining material----------------------.Size: Diameter-----------------------Depth----_--------------------------- Cesspool: �pistance.from nearest well_________________Distance from foundation______ _.-___._...Lining material______-_.._._______._____.._________. � Size:: Diameter Depth L{; u; Ca aci ❑ $ P - --- --------- q d y p tY gals. Privy: iDistan�c e from nearest �eiL__. _W �'`P ,Ar-_'V#M s _ 4_ Distance from nearest building.____-- ----------- - -•. C . ❑ Diatanc .to nearest lot line------ ----------------------------- ------�-_-----i-------------- ----------z ----- # _ _ Remodeling and/or`-repairing describe):-----------------------------------------------------•---- - --------------------------------------- ---- ------------ -------------------------- -------------- ------------------------------------------------ ---- ----- ----------------------------------------- . tit ------------ -•-------------•--------------------------------------- - , I hereby certify that ( ave prepared this apjalication and that the work will be done in accordance with San Joaquin County ordinances, State laws.`and rules and regulations of the San Joaquin Local Health District. (Signed)"`. tkr=l �__ ----- �--�=_ - ----_:= ---=(Owner end/or Con#ractorl By - - ---------- ---- ------ ---- ---- ------ --- ----- -------------------------- (Plot _-----_. - _. _.� (Title) plan;.shaw�ng size of lot, location_of system m relation to wells, buildings, etc., can be placed on reverse side. - .f j FOR DEPARTMENT.,USE,ONLY ' .-�- - 1 APPLICATION ACCEPTED BY_.._--_.__l_.•.. ________________________ _ __------------------------------- ------ DATE----- REVIEWEDBY. -------------------------------- ------------------------------------ --------------------------- ----------------------- -------------- DATE BUILDINGPERMIT ISSUED--------------- ------------------------------------------- V1------__ - DATE------------------------ --------"------------------------- Alterations and/or recommendations:. .V,G_7.-F__--Hf)1j_4--�__ ------------- v .!_ --------/Al.------X/jj 127 _t,r7 ---- 1? t' ----._ . rFZ? 1----------- tri 7A> --------"-tn?~; €�r - .------InoQ._._.. -*} *, . ------------------- - 3 � r` � . ----------------------------- --------- w---------------------------------------- ------ - -_ FINAL INSPECTI Q Date -------- ---------------------------�'_ ---------------------- e-t, SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,canfornia Tracy, California F.P.C{I.