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APPLICATION FOR SANITATION PERMIT Permit No.__.—0_:2.2S nom^" f 9( rnplp+e-.in-Duplicate) /f _ pate Issued -° I 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 �C`ounty Ordinance. No. 549. JOB ADDRESS A D, LO ATION----.�a------------ --- --------�---------- - °.---------------------------k-----------•- ------------ ------ ---- Owner's Name ------ - Phone ------•-- ------------=------------ Address = ----•-----•----------------- { } Contractor's Installation will serve: Residence e A r h=----'---------------------- Phone-l�_.��--- R -_-Apartment men# Dose ❑ Commercial ❑ Trailers Court ❑ /Motel, ❑ Other ❑ Number of wing units: #_l -___.Number of bedrooms __ Number of ba the _,�_ Lot,.size _.-fes. ._-) � _r ~E___.___-_______,__.___ Wafer Supply:-Public,system Community system ❑ Private ❑ Depth to Water table u-ff. Character of soil`to-a depth If 3 feef: Sand Of Gravel ❑ 'Sandy Loam] Clay oam ❑ Clay ❑ Adobe E Hardpan [] Previous App aa�i n Made: es El �Nekw Construction:. Yes ElNo FHA/VAYes ❑ No E]iYPE OF INSTALLATION AND SPE C11=1CATlONS. I (No septic tank or cesspool permitted ifublic sewer is available within 200 feet.) Se tic Ta k: Distance f, nearest we11-----------------'`Distance from foundation-- d-------- Mra iai ' ..r_� --- p No..ofIcom artments_._____ ___ _ Size_ ode th_____' r_ ----Ca acct ____-` p - - -- �' ---- Liquid p (((/// Number of finest___._sa __.__-_. Length. of each Iinea r� ____fit �_�__.Width of renchr ___�--___`--�� p y from foundatian_Q!//._____Distance to nearest lot `e_____}.......... Dis osa field: Distance fro n arest wellA�/..Distance Type of filt7,—m terial__-Si__ _ _____�_ Depth of filter material _._______.Total length__________, 5` ----------- ____________� - p D Seep' ee a e 1t: Dita � ¢ nce to nearest well _- Distance m f unaation__,/ _-•_______.Distance to nearest lof line ----- *____,_._ Qj Number of -------------- Lining material--) -__Size: Diameter' : �r .Depth c p + .--------------- .. i S p l __ .__ ___-_ Distance from'founa'afion _ _____ Lining material______ ___________------------------ El _________ ___ ___ O Cesspool: Size:Diam ten a`e tr ell. --- LDepth------------ -----------: Ir idu1 *�ity ------------ gals ❑ Privy: Distance frgm nearest vrel,l �`" " isfance from nearest Iquildin _____________ '__- p ng _�----- ❑ Distance to nearest -lot line-- _------ ----- :#-------- -- - -- -- -- -- ----- Remodeling and or re airin descrEbe _____________ _______ jj / P g I):.-------------------:-------------------------------------------- --- - ---------•_•--•- P� = f 3�;. ----- ----------------•----------------------------------=------------- ' '`-------- ----- f iA � ,l •,_- t - - a Aa j ________ ___ _ _____________ _________ -__.._.-.__.____ jr-_____......._...._______--______._____-_--.--___-__________________.__--,________________.-_._r___.r__________.____.__-_____..--_________-________--__ ------------- ---------------------------------------------- k--------------------- = •-------------------------------•-------------- ! hereby certify that f have prepared t}sis application and that the work will be done in accordance with San Joaquin County ordinances, t e I sjan les and re ulatiom of a San Jae uin Local Health !District. 5i red .- ( 9 ) ------------ ------ -- -_- _ _ _ {Owner and/or Contractor) F- B t �(�4 `�-`' _=� = =' = = __... Ti+le ---=------ -------------------------------- (Plot plan. showing size of lot, location of system 1n . anon to wells, Wldings,letc., can be placed on reverse side). FOR DEPARTMENT IUSE ONLY a` APPLICATION ACCEPTED�BY------'"---- �-- - - �'---- --------------'-='-`'�----�------------f ----------------- DATE ------1 -V445 ------- -------------------------- REVIEWED BY = _ ----- DATE------•------- .�� .. BUILDING PERMIT ISSUED-------- Fly - DATE / ----------------------•----- � + o�s nd/o re2o ida+�on ..; . ------------ 4) ------------ = � N n iC .t.,,►J 4�-------------------------- ------------------------------------- ----r------- - `f ---- ---- -- `i ! it. ------------ - c --•---------------------------- --------------------------------------------------•-------•-----------------•- - ------------------ ------------- . -----------....--=-1--------- ---------------------•---•----------------- _ �y • t FINAL INSPECTION''BY:._� ----- == �"= " D.afe !` 1 /X43 ------------------------------------ •, �.i, +� SAN JOAQUIN LOCAL HEALTH DISTRICT 1-�..- .... 1 130 South American Street 300 West Oak Street 132 Sycamore $free+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Pevisao 1.57 F.P.CO_