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_ APPLICATION FOR SANITATION PERMIT Permit No. _"Z'�- l (Complete in Duplicate) Date Issued _X/A 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 County Ordinance No. 549. JOB ADDRESS AND t OCATION--- -----------------------------------------Jp � ��7 q-------------------------------------------------------Owner's Name ------- "�_-- --- -Ph �lFd Addressf))M ---------------------- -------- Q $_ Contractor's Name _I�_TL- _� _ + I , Phone = Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ SMotel ❑ Other ...��-r-. tip. -»�.r r:�-7 � - ��_ 1� � ,� y♦ ❑ Number of living units: __�_____ Numberjof bedrooms 2-"�"Numbe of baths_ . "Lot size ___ 1" Appnx "/2 s&-kc) Water Supply: Public.Isystem Community system ❑ Privatel❑ Depth to�Water,Table d f+. Character of soil to a depth of 3 feet: Sana ❑ Gravel 0 Sandy Comm ❑ 'ClaytLoam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes �o l]1 New Consfrucfion: Yes [ No'❑ FHA/VA:,Yes (� No ❑ TYPE OF ' NSTALLATION.AND SPECIFICATIONS: " fill (No septic tank or`cesspool permitted:if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest welf__I ONi=____Distance from foundation_________________ -.-------�- ----F------ -------- . ❑ No. of compartments---- Size---------- 1------------------Liquid,depth---------- -- ; Ce.`aeit .�p y------ ----- Disposal Field: Distance from nearest well'ARQ—`.Distance"from foundation.)-0------_-----Distance to nearest lot line_14_____-____ (� Number of lines----------- ________________Length of each line____ ___ z i� 9 Width of french. �y P Type __Depth of filter material---l�'� Total lengths_-_____2J_� ------- J -------- Seepa Pit: Distance to nearest Iwlell_ Q u � Dist na ce from foundation-__1Q ' g z w `--:x--- w . ............Distance to nearest lo+ line__1(1__________. Number of pits.../________- Linin *material_:*Roe • . ,. } Size: Diameter I-ODepth_ �? -------- Cesspool: Distance from nearest well-----------------Disfance from foundation-------------------.Lining material----- _._.___.____-_________ _- ---- ❑ Site: Diameter -------- -------------- Depth -------------------------------- Capacity----------------------------gals. Privy: Distance from nearest well______________.__ ___________________________Distance from nearest buildin ❑ Distance to nearest lot line - g ---- R modeling and/or repairing {describe:____CONS T LAc}1_'�L1NXIST� ' 'ASM ---------------------------------------------- ------------------------------------------------------------------------ ------------------------- ------- ------ •----- ---- ----- - ----- - - --- --- -- ---------------- -•---- •----- - - ------- -- - - -- - I hereby certify that I have prepared this application and that fhe work will 6e done in accordance with San Joaquin County oralinances, State laws and rules and regulations of the San Joaquin Local Health District. (Signed-----�z�.,c�.-- l �tl�.. ----------------------------------------------•- '-------=-------(Owner and/or Contractor) By:------------------- *--------- -------------------------- ' ---------------------------------------------- --------- -------(Title)------------------------------------- (Plot plan, showing size of lot, location of sysiem in relation f wells, buildings, etc., can be placed on reverse side).' r FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY LZ_ O ----------------------------------"=---------------------------------- -: DATE_-------- --A-57 ' REVIEWED BY-------------------------------------- ----=------------------------------------------------------------------------ DATE------------ --------------BUILDING PERMIT ISSUED---------------- ----- - ----�------------------ -- ----------------------------------------------- DATE_----------- ------------ ----- F ______________________________ Alterations and/or recommendations______________�.__.___._________._ � ---------------------------------------------------------------------------------••--------•--•--------------------------- h -------------_,---••---•---------------•---------------- -------------------•-----------------------------------•---- r f _ ��H I?1-D- T1f_$ �t1 CO.t>1_STR�IGT --------- )N------�7 BH. Pt'_Rvi -----F� ,sR Ar-j--------1_"PnerF iR-'S ----1"5------ ----t - _Q.nsrD 'DAv5N' + 5 p '1�CoNC_FF-rF TI L E y WAIS INAL_INSP TION BY:•-- ---------- • .- —2!a - - ------- • ------- -� ----- ....- Date------------ -- 110 11 �T VNc-r�.onl a� - _� _ IN.L C EAL STRICT r,;7 _ r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, Cali ornia NF-411 LEPOL } L.t NF M A 3� S C�)iTL