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r FOR OFFICE USE: J ........ APPLICATION FOR SANITATION PERMIT Permit No. -a.% . ---------------------- ..................... ---.. / ............................---------.._..... . (Complete in Duplicafe( Date Issued .:�..:1ra�..-fP---� •_-"_.""._."__""_..............,........- This Permit Expires 7 Year From Data Issued " 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. d Y{!Jn/ b C--T- fqn--02 ,W(lferS•N- C_GE�A?I-., /' - -' _ 7Q JOB ADDRESS AND LOCATION. 1tJ Bs84r41' - -t'^••- -- -- -------+"'-" �'` `"•---"'- U1 a• a - 4_ 1 T Owner's Name.---11yNJeY_1�+=- 4i_ -..._ ---_ .. Address. e --- Phone__............... -_ Contractor's Name..__. - Installafion will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .. .%`.. Lot size ---AJZ Ido - Number of Irving units: -...�_ Number of bedrooms ...-.._ NumbJer�af baths -------------- -"--- Water-Supply: Public system ❑ Community system ❑ Private [ Depth to Water Table ...._- ft./ Character of soil to a depth of 3 feel Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay Q Adobe❑ Hardpan❑ Previous Application Made: (If yes,dote._.-..-...,.__----I No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes,IJ_ No❑ TYPE OF INSTALLATION AND SPECIFICATI � (No septic tank or cesspool permiHed if pu6lk sewer is available within 200 feet.) r r . s Se ti ank: Distance from nearest well_-...��..�-..... Dista a from foundation.--_.LQ---_.-Materiel...... .�1i74..... .. ........ pCa act { No. of A-2 _r Cf—Liquid depth.-•--.-.-._._... p ty--�e�..4a--• i Disposal ieid- Distance from nearest well__._'�__�_.Distance from foundation_.�!?�..___Distance to nearest lot IineS._;_.-._ Number of lines....._.. r.--_._. Length of each line____.G7.-..-.Width of trench.......0r;........... ...__ Type of filter material..... .:.....Depth of filter material-_-/_Q._....--Total length..-.--s+.f.-.3.Q- I See it: Distance to nearest well..-_.f99!�._.Distance from foundation....L4.._r_Distarnce to nearest lot line._�....._ f [� Number of pi+s_.._.-L---------Lining material..._.sSrx1<---.._..Size: D-iameter_._3l1..a_.-------Depth.....,?.5.....___..._.__ ,S<escpeeF: Distance from nVrest we1L-1.Qd....Distance from foundation_-ZO.........lining material.....1 `......_.__._........ ( l She: _.....Depth. --.-..._. ........._..........----- e I Privy: Distance from nearest vre6_.__,.,_._____..___.._....._........Distance from nearest building-----___.__....__-----......... ❑ Distance to nearest lot line_.,__.-.-._.._-_-_...--_"_----_._..___.- --•---_....._.__..._...--__--___.-__._._-.- 4 Remodeling and/or repairing (describe):."..._._.___.._....---__._-..._..__.__-----------__............................................ -.__-...____.._--. ---------------------'---------------------------- .---- ._ ..._-._._..__.—._-.____.._._._._.._ ..__.-._._._-___-.._---•------._.___..--•----___..- 1 -------------- -------------------- --- - -- -- - - --- --- ---------------------- — ---------- --------------------•-'--------•------ —— -- -------...---------------- - ---- -----" - ----- ----- 1 1 herebyy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St , end rules and regulations of the San Joaquin Local Health District. -.- ....r ..,•__.......i..._F,_.,= .s._-t - . _ r..Contract ... in D(dand/o ort (liNe}-------------------.'- ...... - --.....-- (Plot plan, showing size of W. location ofsys�im tin relafien to walk. buildings etc cow be placed on reverse side} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...• ._._.----- ------------------- --------- REVIEWEDBY....................... ------_.--'- --____....................- --'— --- . DATE------------------ - ---------- BUILDINGPERMIT ISSUED_. ...._. __—.--- ___- _.._..—.__.._____ DATE __.---.. _._._.----_---.._.........__•._..... Alterations end/or raeommaadatian:___.._...___..__.---_-----------_._----___-_._.__------------.------... ._.....-....... .....__._.._.__........... -.-..----._.._.._...--_..--_.._ ......_.._..,._._..._-.-.........-_..._.__.__.........................__-.._.-....._._...._..___.-._.._—_----- ..---------__....... .................................... ...................._................................-................--_.__.__..."............-------.- .................................... i RNAL INSPECTION BY:...... - Date-- - .................... �.._.-._.__. ��- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.NaeNfen Aye, 300 Weal Oak Slreef 114 Sycamore Street 101 Wast 91h Sheet Slacklen,eallfamio loth,eanfemb mosw.,a,Ca lifer.is Tracy,Collfornio EP.CU.