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_f nVII ,VL VJL: . . .................... .. n, ,..?LICATION FOR SANITATION PER,e(IT /Permit No. ...�- ----- ............ (Complete in Duplicate) X 'o ___________________________ This Permit Ex izes-1 Year From Date Issued �yy I Date Issued ..--- 4:1 ppRca#ioin sh@�byyy��ppde to the Sen Joaquin Health District for a permit to construuct end install the work herein described. This applicon is madatin compliance with Lnty Ordinance No. 549. �J� �/JOB ADDSS AND LOCATION. . ---y-- I---RF�IS� -RT - '------.... �L-.,��L1.ZP--�-.__.L.--/----. Owner's Name-------V -C. .- _-1JSJ-Rat- ---- --------- ------- - --- -----------'---------------------- Phoneh ! Address--'---+-,-M.'L ....l3Qx_- J7$�-------- HBQP----------.....................-.........................__-__- Contractor's .-_:-._-Contractor's Name Q IAIIV R...----••-•-----.•.... ------ ----------........'..................................--- Phone----....................... -� Installation will sery Residence s�J❑ Apartment House �J Commercial ❑ Trailer Court )her Number of iving units: -d.-.- Number of bedr s -Q._. Number o baths Lot size -. p/.+ --- Water Supply: ublic system ❑ Community sys ❑ Private Depth to Wafer Table .. .__ ft. '-�� Character of it to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay ❑ Adobe❑ Hardpan ❑ Previous Ap kation Made: (if yes,date------- ---_------) No 9-_INew Construction: Yes No ❑ FHA/VA: Yes ❑ No L_ TYPE OF I STALLATION AND SPECIFIC TIONS: (No 11 epfic tank or cesspool permi if public sewer is available within 200 feet.) IR Se tic anit: Distance from near well- 0.---Dista eyL�from foundation... _0...--..Met ria(_..!-lD�Q-eV--D-.-----_--- p No. of compartmen ...... .Z�.-..-.--Size�.tt_1�X_s57__Liquid depth...... ..-------------capacity... /Q t"7 Disposal F Id: Distance froem near # well---3.010..Distance from foundation--..�- _. -.-.Distance to nearest lot line- %5--. [9� Number ofli --.-_....................Length of each line-. Width of trench... Type of filter al_--R0-01'0-:_-Depth of filter material__. .,�__jy---.To#al length.__.._......-...:_ - Seepage it: Distance to nearest well----------------------Distance from foundation._3---.{�.-------.Distance to nearest.lot line-------_-._._ ❑ Number of pits------------- ------Lining material--------.--------------Size: Diameter-----------------------Depth....................._____ Cesspoc Distance from neai ast well...........___-Dis#ante from foundation....................Lining material................................._ ❑ Size: Diameter------- ---------- ..............Depth......'...........---............................Liquid Capacity.......................-...gals. Privy: Distance from near ist well.............--_-.__.___---.__-................Distance from nearest building....................................... ❑ Distance to neared lot line--------------_-----•-----•----------------...................'-............_..................................................-- Remode ing and/or repairing (descriI _---------------------__-----.__-_-_.------..--- - - - - - 1 herela certify that I have prepar d this application and that the work will be done in accordance with San Joaquin County ordinan es, t e laws, and rules and r ulations of the San Joaquin Local Health District. (Signed . - ---- .._ ... -- -- -- -' -- .---------------------------------------------- ........ -- - (Owner end/or Contractor) y:--"---------------------------_-- '''-'--- -----------------------------------'--------- .........lTitle).............................................. ............. - (Plot pl n, showing size of lot, locat tem in relation to wells, buildings, efc., can be placed on reverse side). iliAj FOR DEPARTMENT USE ONLY APPLI TION ACCEPTED BY- Q - - -- — DATE t? -�/ - - REVIE ED BY....._....---- ------------------- --••------................... DATE...-....................--'-------------------- BUILDI G PERMIT ISSUED.------------ - ....-.....................-------------------------.................. DATE................................................... ns and/or recommendations:--- ------ ............................-----............-----•----------------- -----•---------•---------------.....------------------------ - ...................------------------------- ----------------------- ----'---'------------------------------------------------------.-._---•.-.-..------------`---•-.------ ............. ................................................... .... -------------_.......................•.......---............... ..r_,..--------_---•-------------.- -------- ----- ... --- -'- -r ....... - .......................-..... s.... -- FINAL INS B ------ - ----- Date---- f ..�_, .....-`.-.:......1.....---- -•-----'` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California u-e ecvnoo• as r.nc o.a.r a ev