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FOR�OFFICE SE: `---- ------ ------------ ------------------ ___ ------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. {Complefe in Duplicate) Srtrrwr.•jC9- t/E '•r Date Issued -=----------------------_------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install theme workher in described. _.. ,This ap lication is made in compliance with County Ordinance No. 549. q"r)�ROP d S'! pE_� C JOS ADORES AND LOCATION SCM H- L.L/ l�--fit ----------- 00 --- -----OF----- Owner's Name______________ / _- - --------- --------- - ------- - -- Phone---•----------------------•---•---- Address-------------- --�Q X �_ 3.� /A. H Contractor's Name_-__.Q_-l?f\!EPS-----.-_---- Phone----•-------------------•-----._.._ _ Installation will server Residence�QApartment House ❑ Commercial ❑ Trailer Court ❑ Motel [) Other ❑ Number ofrl vi g u s:" -----`Number of bedrooms f_---rN�um�be o baths -1----- Lot sizeC7---------------- Water Supply: Public system Community system ❑ Private ❑ De;pfh to Water Table . -_ ft. 11 Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------_ $ 7 No � New Construction: Yes Ef <o ❑ FHA/VA: Yes ❑ No2!r, TYPE OF INSTALLATION AND SPECIFICATIONS: lam. - (No septic.fank or cesspool_permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -pistance from foun a}ion_ ter al CVA1ek-C r p d jp__ _ Ma ni No. of compartments:------2_ ------- Size_ X9 x !_Liquid depth--.� �--___ __Capacity__7-0.5.2------- Disposal Field: Distance from nearest we4..CW_:.._Distance from foundation_____1 ....Distance to nearest lot line__-_-�_... ®� Number of lines----------I- - - ----Length of each line '--_-- --` --------_.Width of trench,------Z - !, - --- ------- Type of fiiter material-----�QC.&---Depth of filter material------ length--..___I_____________�----_-.---- . - - ,.,.. Seepage Pit: Distance to nearest well_____________________Distance from foundation_________-_._...___Distance to nearest lot line_---__--------- , El Number of pits----------------------Lining material-----------:----------- Size: Diameter-----------------------Depth------.--.-.--------------------_. Cesspool: Distance from nearest well-----------------Distance from foundation--_________..Lining material_-.-__.....__..______________-- ❑ Size: Diameter------------------ ------------------Depth----------------rf --------1-1-11"I--------Li uid Capacity als.� 9 p Y --------- 9 Privy: Distance from nearest well___________________________________________"r._Dista'nce fr6m nearest building____.__...__--- ❑ Distance tonearest lot line----- ------- --'t---------------- - ----------- ------ ------- --- ------- -------- -------- Remodeling and/or-repairing (c�escribe)�'; .__-. r R_.----AEA T_-JO-B-----QINf--- ------- --'----R� 1l1�CrQL� D. -r----END ---- --Rou-41-----R_I"�_wobD----- �M_ T �4A QF •` s----�- D CaRPL S FIFjT_.__ `tt4)_�" sr � -----w, SevuGl A -ls _ ` ------A. I hereby certify that I h ve prepared this application and that the work will be done in accordance•with San Joaquin County ordinance State aws, and rul s and regulations of the San Joaquin Locai_Health-DistriZf;" (Signed -- -- � �. ... ._...�..___.�-._ --- ---- .. . ------------------- ----------------------------- ------------------------------------------------(Owner and/or Contractor) BY•- '----------------------------- ------------------------- ----------.--------------------------------------------(Title) --------------------------------------------- (RloVp an SKOOiing size of lot;location-of-system in-relation to•wells,-buildings,-etc., can'-be--placed-onrreverse-side).--+�•— = FOR DEPARTMENT USE ONLY ' AP KATION ACCEPTED BY_...__rT,._F �Q_ -------------------------------------------- DATE------�--------6--� - ------------- -- ---- I E EDS BY---- --------- DATE BUILDING PERMIT ISSUED--------- ------------- - - DA•TE----------------------- --- ------ ---------------------- Alterations and/or recom endations:__�4G_-___..�aT/ IDS.[ __ - Gt9_lt ___QISTt - / - ---_- D- - IE/Vr 1'kJ-MSN-1?-----' -,[ ----NQ-------14�`PLOpj_------E .,_ K /�.�--.---`o?----.--13R1N451 -._rAIy_K P G'�_).�-- f CA t._----$-fes.----EXPE�Tf�=. .--'f'�----- i9Tr -�- 9- DAF' rCl3 ----- PQSS133 -Ll� -- Qom. cc-T ----------------I----- -------------•----- --- -- ----------------------------•--- ----- ------------------------------ -- ----------------------------- FINAL INSPECTIO Y: - -p -[� .y-- Date------- 2 ---------------- --------------------------- Gr O I AL HEALTH DISTRICT 1601 E.HaselFair Ave, 300 Wt Oak Street 124 Sycamore 205 West 9th Street �r ese Street Stockton,Cdlifornia':`' Lodi, California Manteca,California Tracy, California