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------------ -------------" ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ' ---------------- ------------------- -------- ---------- (Complete in Duplicate) ----------- --- This Permit Ex fres I Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in I This application is made in compliance with County Ordinance No"J549. stall the work herein described. JOB ADDRESS AND LOCATION.___- 1ZSTRf�TF�_�-p ,U�TyRop ---+ ��_t- ► AL1 N Owner's Name ----------- — Lpfi 1 ------- Address--- G / l�l�- .- T�lTQ �_ ;; Phone ----------------------- _FSQ� Contractor's Name_ Q- E -- -- --•---------------------------- -- Installation will serve: Residence ❑ Apartment House ❑ Co�ercial ------�---"----"--"---"----"---•--------- Phone �� - ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _V•---_ Number of bedrooms _ -- Number of baths Lot size Water Supply: Publics stem CommunifiY system Private ___`__ __2 " -------" -"---""-- Dph to Table Character of soil to'a ;depth of 3 feet: Sand Gravel ❑ .Sandy Loam ❑, Clay Loam ❑ Clay a Previous Application Madero. If' e's date. Y ❑" Adobe ❑ Hardpan ❑ ! ( ��' � � j No ��New Construction: Yes o FHA/ VA:OF INSTALLATION AND SPECIFICATIONS: 4 R ❑. FHA VA:Yes. No T– - Yes septic tank or cesspool permitted if public sewer is available_w.ifhin 200 feet. F Septic nk:� Distance front nearest well__,-- --."_ iAJfR,i�-� �Lf�ST�� ��'_Distance from foundation..... l� No of com artments_ � Material- �,� r �. . � Liquid��d}epth__. �------ CaPaatY ©- - Disposal Field: Distance from nearest�/well-" ,- .--_Distance from foundation--- Number + N ember of ginea ___---_(- Length of each line------- __ Distance to nearest lot line--- ---------------- ------- _ �~ Q�j�-��- Width of trench_ .__ "--_ Type of filter matenal.__�i�_�K Depth7of01- 1 �filter.maferiaL__-__/_ --_ length - Dumber.o$ �� Total _ f -- Seepage Pit: Distance, fo'nearest well...C,-� / rs " r T � I �4f.. }Distance from{foundation_____ S � t ,pits.----__--- -- r, Q Distance to nearest lot line----------------- l ---- --Lin ng matel_ 1- f --Size: Diameter----X- -- ------De tn_------ Cesspool: Distance frkm�nearest well------.----------Distance from foundation.__----_--_-- p W -Lining material--------------- Size: Dia eter------------------ �_--------Depth------------------------- ----- Priv � I ��" _, ------- -------- Liquid Capacity gals. Y: Distance from*nearest-welly*-�_--+�* + !t: I J W-- Lsz f .__ ._ Distance from nearest building-- ------ ------------------------- - ❑ Distance to-nearest lot""line'_""'#�It�.�_ ___ - f � Remodeling and/or repairing (describe):---- [ ti1�_Q1 � ` -----------1 -EN_Ew p _ l-r / _ ._R._ - P�_ D- - gcfSc ------------------------------ "' t ------ ----- ----------------- ---••----------------- - -- f �- ---------------------------------- I ' y r.1?p N 'd fha y y - _ . „gi---------- ----------------- at ' €i SY o # ----------------- ----------------------- ---------------------- hereb certify thI have prepared this a lica#ion an f the work'wifl be.done in accordance with San-Joaquin County ordinances, State laws, and rules and.regulations`of the San,Joaquin Local Health Dtsfr+cf- i (Signed)--- tiSo 5±� -----__-_- ------- _ r IF _ �! 7 .. ., :�:� n. - (Owner and/or Contractor) 9------- ---- ----- -�-_ ,r_ , ---- (Title)'Y" 1 (Plot pla awin size of lot, location of system in relation to wells, buildings etc., can be placed on reverse side ).—� 4 FOR DEPARTMENT USE ONLY APPLICATfON ACCEPTED BY-------` �_ ,_ n" REVIEWED BY ------------------------------ DATE �77 �� BUILDING PERMIT ISSUED ) DATE ----------------- ------------------------- - f i -- ---------------------- aerations and/or recommendations:-- � C�,[q�� --------- ------------------ 49-- --------- ---- --1----1--------- ----------------- 7 ' '- - --------- -------. FINAL INSPECTI �'--- - ----kn-L- ., �� Z/_ 1 ` f- Date - - ` 1 '-------------------------- SAN JOAQUIN LOCAL HEALTHDISTRICT jJJ 1601 E.tlaielfon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,California Tracy,California �J'