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FOR OFFICE US> .7 --."----------------------- --------------- `_—:_s APfLICATION FOR SANITATION PERMIT Permit No'. (Complete-in Duplicate) ' , this Permit Expires T Year From Date Issued Date Issued Application is hereby made tolfhe San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application i's made in compliance with Co un Ordinance No. 549. .2Y—/—(&O--,p 7 �- JOB ADDRESS AND LOCATIO -------IDE__- Qhs_I` ,..-•- -D---��-.- "'s --OF-----IV►---'I - R-t- Owner's Name_------•----X F----- Address.................... ------- --"r FsclLo Contractor''s Name_- L. � v)-C ---- ------- � ��r f Phone__i62_' 17 Installation-will Serve:„ Residence ❑ Apartment Hous ❑ Commercial ❑,jrailer,:Court E] Motel ❑ Other s1 r omt5 Number'of living units)'- Number of bedrooffm .. Number of bath`sJ" Lot size /��}C�_ 14 _ I Water Supply. Public system ❑ Community system � Private -+:I3epth to-Wa#er••Table !_— _ ft Character-of soil to a depth of 3 feet'-1Sand-®--_Grav€I ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan• ❑ Previous Application Made: llf yes,date~'.`.p'".___--_-._- J No��Jew Construction: Yes to~❑ FHA/VA: Yes ❑ No l i� - -'� TYPE,-OFtINSTALL-ATION-AND-;,SPECIFICATIONS: € �[Noseptic tank or cesspool permitted if public sewer is available within 200,feet.) p is ` ;k,: r Distance from nearest well�57- �Q___".-___-.Material --CQlVCR FT --- 1 Disfiance from foundation__._ _ Set _ No. of compartments. .._.. .-._..-.}_Size_sx).V__x_5_____,Liquid depth_- 'z-----------Capacity__ /5b P____ P " DispasahField: Distance from nearest well,_y._._._..__."_Distance from foundation------- -----------Distance to nearest lot line----- ___-___-. Number df� n�es=t___'_.__ _ Len th�hof each line__ _____ -----� --.Width orerch . �6 ��--'--'-'----• Type of filter?mtenal...RQ.CK----Depthlength ' of filter material___-fg . Total length_______-_i_. __ Seepage Pit':'\ Distance to nearest well......�-Q_ _._"..-,.Distance fro-m foundation-�Q----__------C�istance to neare'st�,lot lines_--_-____--_ Number of pits-�- -_/-------------Lining material _ Size: Diameter.'` .x _/_z_----Depth"-_._x.___1.�___._.____ I 1 J Cesspool' ' Disfance from nearest well ---------------_ i"fande from foundation----------....... -.Lining material--.-_____________-.-____-.______---- ' [] t Size: Diar'imeteT. - _` Depth ---------------------------------Li uid Ca acit __. oA I " pq p Y - 9 Privy: Distance v r nnrinearest well___-...__-_-__I-_______________-.._-...._ -_Distance from nearest building_-_-.-__---___-_________________.___.-. ❑ Dista to nearest lot line ....... :-----------------• ------------------------------------ -------------------------------- -------- -------------------- --- 1 1 s 1 ---- Remodeiirrg and/oar Y F I — V repairing (descz�be):--------------'--------- - -- --•---• -- -------------------------------------------_-------------__--__-__-_- 1 --- --- r3--1"'1 F 1 ..........____----------------------------------_____-._--- ______-____-4____--__-________-_. ------------Y__.___________-___-_____.______._---_-----__________________.__.-___-_.._------- ..--._ I hereby certify that I have prepared this application and that the work will be"done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (signed)- '�' ------------------------ -------- - • -- ----------- ------------ -- r and/or Contractor) ` BY:--------- ------------------------- ---------. -------------------------------� --------- - ••------- -(Title)-- � �-� ------------ --- - - ----- ,.-- - (Plot plan, showing tsize of lot,-Iotation of system in relation to wells, buildings, etc., can be placed on reverse side). ' .y FOR DEPARTMENT USE ONLY REVIEWED BY, - `_= DATE ��` ?�` 6 APPLICATION ACCEPTED BY'R-:._, ___t_ __ - __ -,-__ ---D Tf --------------- -- i BUILDING PERMIT-ISSUED `'! �- ' --- ------------------------ ------ _ DATE- - ---- -- ---- - Alterations and/or recommendations:-. ---------- ................ --------- ------------------------------ --------------- 1 --------------------------------------------------------------------------------• - --------------' - " ------- T y :-------�- ---- ---"--------"---------�.;--- ----- - � ---- � -- -' " ' -------------------�- ----- --------- -- ._. -------. - _ FINAL INSPEQZ Date. ' ' ' Z -- 6 -- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy, California " E.H.9 2M t-67 Vanguard Press ,