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FOR OFFICE USF <br /> �—- -- ------- ------ 'r_.r +c <br /> C <br /> LIATION FOR SANITATION PERMIT <br /> �� Permit No. <br /> APP . _ <br /> C -fes_'_--- {Complete in Duplicate) /5 a <br /> --------------------- This Permit Expires 1 Year From Date Issued 7Date issued W <br /> Application is hereby made to the San Joaquin Local Hea{th District for a permit to construct and i�a7l the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- -- - ----- r�._._.�Il� i ------if '--s e, ----�lf�'__.�S�- U&/&--------- -- <br /> Owner's Name------------���D--(�`'-��._.��/ -�_f�_ .----------------------------------------- ------------------------ ----------------------- Phone--------------------- <br /> Address------- � r � <br /> Contractor's Name---- f (� ./ cr <br /> 11*7----------•------------------------------------------------------------------------ Phone...---••--------------. ------------ 4 <br /> Installation will serve: Residence Ata i artment House Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> ❑ ❑ <br /> Number of living units: N cft er of bedrooms. __ Number of baths _ __ Lot size - � <br /> -- ---------- <br /> " F <br /> Water Supply: Public system ❑ C60' unify system El *6epth to Water Table 'ft. <br /> Character of soil to a depth;of 3 f 'et., nd E] Gravel E] Sandy Loam [-IClayLoam ❑ Clay ❑ Adobe [��HardpOn ❑ <br /> Previous Application ppcation Made (If yes,1cf,a ----------------) No New Construction: Yes E??'INo E] FHA/VA: Yes ®—• No ❑ y <br /> TYPE OF INSTALLATION-AND SPECIGATIONS: ra l <br /> sspool perinied if public sewer is available within 200 feet.) (� <br /> Septic Tank: P Distanoe;zfrom n <<a <br /> No septic dank or ate <br /> u <br /> ` ` 'eare� :w IL_t _..___Distance from foundation___A0______ .Matenal__ _flf` <br /> ., .r ...............No. of comp6rtrne.ref -------------------SizevO-iKR�S �[ Li uid de th----- _-- <br /> --- q p �-- Capacity,l .__. , <br /> Dis osal Field: Distanc, :from ne resfiKI ' <br /> � well _._-.._Distance from foundation___/ __.__....Distance to nearest lot line_r�!__ <br /> Number.of hones _ ur y"_.� _Length of each line---?r`s'`__ __. _ -.--Width of trench._yZ�______.__ --------- <br /> -0-1 <br /> T e 'bf`filter::m1 .-Depth of filter material...21r, __.-Total length___.! ------------------------- <br /> Seepage <br /> ____ _ _____________ r <br /> Seepage Pit: Distance to. nearest '_______...____ _Distance from foundation--------------------Distance to nearest lot line---------------- <br /> [� Numer,of pi#s-_- ;-:_--Lining material_._- °a��_.Size: Diameter--�P_ ----------Depth <br /> _..IQ_ ----------------------- ¢ <br /> Cesspool: Distance.from neer s,iWell-----------------Distance from foundation......--------------Lining material- .---------------------------- <br /> El <br /> ----_-_. _____.____ ___❑ SD�ameter-,--:.' � -=-------- ------- Depth----- - - - ----------------- -F----- -_----Liquid Capacity— - - ------_gals. O <br /> T. <br /> Privy: I Distance from nea-re5�`C�eIl------------------------------------__ _________Distance from nearest building_______.._____ __________ <br /> ❑ Distance to nearer Ivt line-- -------------------------- --------- --- ----------------------------------------------------------- <br /> --------- ------------------------------ ------------- <br /> Remodeling <br /> ri <br /> Remodeling and/or repairing (descbe} - ----------------- ---- ----- ----------- --- .. . <br /> ---------------------------- --------------------------'::` _—? ' --------- ----- ------------------------------- <br /> t <br /> u ------- ; <br /> ------------------------------------ ------ ----------- -------- <br /> ---------- ------- <br /> .. .. t <br /> I hereby certify that I have prei a e,;,-- application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, State laws, and rules`an&T-99'ulafions of the San Joaquin Local Health District. ` <br /> {mor Contractor)----------------------------- <br /> (Signed)--------- <br /> (Title)-= = (Tits _ 4- -------------.... --------------- <br /> �,r <br /> e) <br /> (Plot plan, showing size,of lot, location of�sysfem in r aon to wells, buildings, etc., can be placed on reverse st e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY'_'- _ <br /> DATE -----� �------------------------ <br /> k i r -------- ---- DATE- --------- ----- - --------- <br /> REVIEWED BY----- "-- "_:_._:_°_ r DATE------------------------------------------------------------ <br /> ---- <br /> ----------------- -- <br /> SUILDING PERMIT ISSUED -- ---------------------------------------------- <br /> T <br /> Alterations and/or recommenda+ions _ ': S ( ��-.�__-�1cPC _ D <br /> % �. Z a �` `" - ----- -- ----------------------------------------------------------------------------------------------------- <br /> --------------------------- ------- <br /> ----- ----------- -------------------------------------------------------------­ ---------------------------- -------------------------------- <br /> ----------- , �. <br /> y; <br /> l" <br /> Date--- -��_~�`�� --- ------------ <br /> FINAL INSPECTION BY:. f <br /> FSAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Hazelton Ave, 300 West Oak Street '124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy, California <br /> F.P.C C. <br />