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FOR OFFICE USE: ----- - -- - -- -------- ' Jg _--.-_--___------------------ APPLICATION FOR SANITATION PERMIT Permit No. . �...:5�1. - ,.,�,._. [Complete.in Duplicate] J r Z-Z� -:- ----------- - ---•------ -- ...._.�... .._..F �._ Date Issued , - . 0 --L This Permit Ex ires 1 Year From Date Issued _ `ZCei ��U p� Application is hereby made to the San'Joaquin Local Heaffh District for a permit to construct install the work herein escri e This ap}'I cation is made in compliance with County Ordinance No. 549. ff/ l1VL)}eQTECq 54 DF_= 4-1 / i � JOB ADDRESS A DLO ATIO STH 4T-I _G Owner s Name P - l i Addl---------"'—_L:��`Y �:1�, }`��-LAN_.�5-- ------ {0,qNTFCJ ------------'{ - --- -- ------- - ------- Contra or s Name-- I �` rp �on'e = - fl- I Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ G4 j Number of living units: __f_____ Number of bedrooms _ INber of baths Lot size ______104._X___44? ______________________1 I Water Supply: Public systt m!PA]�Commun y s, em,❑ P al epth to Water Table __6__ ft. + ' Character of soil to a deph"eof 3fee5a�r"d Grael-� 5and_y'Loam ❑ Clay Loam [3 Clay E] Adobe ❑ Hardpan [� Previou#Application Made: (If yes,date _______________----} No _ New.Constructi jn: Yes ?a---No ❑ FHA/VA: Yes 2-,--No ❑1, TYPE OF INSTALLATIIONN.AND�l-S"PECIFICATdO�NS: PNo septic tank or cesspool permitted if p/blit sewer is availablsw �n-200 feetA7Mfe, t 5e tit nk: Distance fropm nearest weIQDs}anc��m � n��lq�� depthlal:--_ ��- _J I No. of tom artments-._._ Size:., p y Disposal geld: Distance from neatest wefl__.�? ----Distance from foul,Flativn1 -------Distance to nearest lot line_____�7`.� ' i Number of lines------- __ _______________Aength ofkeach lineNN75_� __._.Width of french------ .�`----'______.__{ Type of filter.material--R6 }�� --Depth th of filter matena 1_ Total len th_________ - �/__�__________-} Y p p � 9 .� + Seepage Pit: Distance to nearest well-----_------- ------Distance froINfoundation� . ________ Distance to nearest lot line-----'__.___!.:-,J' ❑ Number of pits------------------- +FLining material-______________�+__.-.Size: -diameter__ ;__.____ Depth_ Cesspool: Distance from nearest well----------------- from foundation _.Lining-,;material____-___---_�� I� ❑ Size: Diameter------------ -�'-------- p iq • a Dept ;......--j Li wd Cap �ttY �� gals l Priv El Distance to Barest lot'well________________________-____________________D tante from nearest building_ �'` ,-- _-_________.__._.___-.- Y ' line. "" --------- F ------------------------------------- Remodeling -------=---------------------------- Remo p deling and/or repairing (describe:- ---------- -- ----------- - = �-�- N°� - -� rA` �.1 _ 7H� -----=T-M iklil --------- F ------------�-- ---------------•-1--------I------------------------------- --------- ----------I--------------0 .---------------------.. I hereby certify that I have prepared this application and tha+ +he work will be done in accordance with San Joaquin Coun+y ordinances, State laws„-and rules and of-the San Joaquin Lacal HealthDist-rict: (Signed--(5 ` (Owner and/or Contractor i Y •a: ,: ---------a: - - - - - - - - - - -- -- - -------- -- ---- --- -----(Title)- - ------ --------------------- I ” -(Plot plan, showing stz� of lot, location-of'system'-in:relation to"wells,buildings,-et:; can be.-placed on-reverse sides.-_ - .- FOR DEPARTMENT USE ONLY _ n APPLICATION ACCEPTED BY------- -. . '----------------------------------------------------------------- DATE-------h�_77_4. ----------------- REVIEWED BY------------------------------------- ------ -- ---- ------------ ---------- DATE------------------- ---------- BUILDING-PER:MIT-ISSUED-----------------------.---- -. � _-� DATE-____: __z.—_�--=-==:_�.-- ----------- Alterations and/orrecommendations:_ ------__________ --------------------------------------------------------------------- -------=---------------------------------------------- ----------- ------- ----------------------M •------1 TV"___ -------------------- --- ----------------------------- ----------------------------- F FINAL INSPECT! ------- -- ------ A Date---------&77/ -7-t/7-8--------------------- --•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8.59 3M 3-'63 F.P.0 C.