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FO ,OFFICE SE: k ---- ------ rm., No. -------- ---------------------------------- APPLICATION FOR SANITATION PERMIT pl?�i ......... ------ ------------ -------------------------------------------- (Complete in Duplicate) --------------- T1 ---------------- ------------:----------- This permit Expires 1 Yea'r From Date Issued Date Issued Application licitiion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T application is made in compliancerii� 07e)rclinance No. 549. JOB ADDRESS*AND LOCATION --- ---- - ---- ----- "e-------------?4 -- -- -- -------I--------------------- - -- ------------------- ........... Owner's Name-------�r,0.77 :%e/yl------ ----------------------------------------------------------------------------------- Phone...--------------------------------- Acldress-,---,2..g3. ....6 Ae --------Pef Contractor's Name.---Aeo*- -----------------------------------------------------------------------------------1------ Phone-"--........•--------------------- Installation will serve: Residence P-*"Apartmeint House 0 Commercial E] Trailer Court. [:] Motel L1 Other El Number of living units: I--- Number of bedrooms Number of baths it;n Lot size__ - ---------------------------.......... Water Supply: Public system E] Community system ETPrivate E] Depth to Water Table Character of soil to a depth of 3 fedf: Sand E] Gravel [] Sandy Loam [-] Clay Loam E] Clay El Adobe ff---Hardpan E] Previous Application Made: (If yes,dcite--------------------) No � New Construction: Yes Z?-No [D PHA/VA. Yes WR,'No M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool. pe'rmitfed4f public sewer is available within 200 feet.) :Y-, Septic T9 nk: Distance 4ri;� Distance-from, No'. of cp` mpartn�bnts...x�?----------------Size"-�50A'A!kYeLiq`uid depth-----Ik-/--------------Capacify./,ZA04!----- 'Disposal Field: Distance'from nearest well---------- -------Distance from -Mce to nearest lot line-&2-7." foundation---69...........Disf6 Number of lines-------- ----------------Lengfh of each line-----/1">j-—-__j-_______________Wi8A of french--eZ--" ----------------------- 4erial Type of filter rna -1t�,�- 4-.oe Depth of filter material___ -________Total length___ ___________________-. Seepage Distance to nearest'well______________ _----�Disf6hte from foundation---,,"P \j -.`-.Distance to nearest lot linet;;.I�—------- E�r Number of pits_____A—------------Lining maferial-4e- jPx*0e---Size: Diamefer-�..�- ------ Depth---.Z-, Cesspool: D 7 -0 .1 isfance from nearest-well---z-_-----------Distance from foundation--------------------Lining material__.-_-_-_.____________-________-_.__. Size: aterial--------------------------------- Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.--------- ---------------gals. Privy: Distance from nearest well-,-- ----------------------------------Distance from nearest building-.--------------------_--____---------- D"istance'-fo nearest lot line' ---------------- V - ------------------------------------------------------- ------------------------------------------------ �f---------------------- Remodeling and/or repairing (d05cribe):-------- aqZ�------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------x ---------------------------------------------- --------------- ------------ -----------------------------------I-------------------- ---------------------------------------------------------------r-----------------------�-]-------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------•-------------------------------------- ---------------------------------------------------------------------- I I hereby certify that I have prepared this-application 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. eve- ----- ---------------------0e, (Signed) -- ------------------------------...(OWNFORt�'or Contractor By: ---------- -- -- -- -- ----(Ttle)-----A 0411M,------------- --- - -(Not --------------- plan, showing size of lot, system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYJ-f-- ------ ----- --------------------- --------------------------- ------------ DATE----- fir' ' REVIEWED ATE------ REVIEWED BY------------------------------------- -------------------------------------- ---------------------------------------------- DATE BUILDING PERMIT ISSUED-----------------------------------------------------------------------------------------*------------ DATE------------------------- ------------- Alterations and/or recon ptenofion - ---------- ----- --- ------- ---------------------------------------------------------- ---- ------------------------------------ ----------- ------------------------------------- -----------/ -7 .. 71------ --- ------- ----L--- ... --------------------Q... •.........�7 ------------------•-- ---------------------------- ------- ---------------------- ----- ------------------------------ --------------------------------------------- --------------------------- ------- ----------------------------- FINAL INSPECTION BY:.---. ----------- Date- ------- SAN,,JOAQUIN-LOCAL HEALTH DISTRICT_ \1 , 130 South American Street 300 West Oak Street 7�4 Sy..'mo-"N Stre- � ' re et� 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 PCV10rD 6.59 F.P.00.2M 6-60 %.