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APPLICATION FOR SANITATION ,/PERMIT Permit No. (Complete in Duplicate) A Date Issued /' This is hereby made to the San Joaquin Local Health District for a permit to consfru ---7�4/ 's application is made in compliance with Count Ordinance cf and County r inancedlo. 549. install the work herein described, JOB ADDRESS AND OC W-r- Owner's Name ar ------ ...4 ------------------------------ ------------------------------------------------------- Address -------------------------- ----------- _44Q&41--------- -------- Phone Contractor's Name- --------- J� ---------------- - -- ---- .... . --------------------------------------------------------- ------------------ ------ ---------------------- 4 + Installation will serve: Residence &�Apart Z - -------- -- Phone--------------------- menf House [I Commercial 0 Trail Coin -------------- Nurhber of living units: --/--- Number -f , er IJ Motel ❑ Other Ej Water Supply: public system . rooms -k- Number of baths , r, I., LI--C,-o 'if /----- Lot-Fs',Z`e(�_Z) /_ZW11------------------------------ Mmun,if system E] Private 0 Depth to Water T Character of soil to a depth of 3 fee+: of' a e ft. % F Sand,E] Gravel [] Sandy Loam Ej V_ Previous Application Mede: Yes C] I Clay Loam.U] ,CfayO Adobe I I No P` ❑ New Consfruc rk 94"TP-ardpan Ej TYPE OF INSTALLATION tion: Yes E] No Q- FHAP ON AND SPECIF ..AJYes"E] No (t:ATIONS: (No septic tank OceVice'sIsPool p;rWi4ed if public sewer is available within 200 feet.) ,septic an 0. of ifrom nelrest well-----------------Distance from four7clation Tank: Distance( N A, cbmpartAenfs ---- ----- Material Dispal iefd: %� ------- ------------------Size-------------------------------Liquid d ---- ------------------------------------------------- Distance from —Ul"- "Di' foundation_ Pyh------------------- Capacity-------- -_ --------------- . * rn nearest well) stance from foundafi I ----- C$�_/ /50&1 Number of i,'5435-----------/------------- Length of each �;ne_00 V--U-1------Distance to nearest lot line TYPe of fiifer material -V,�-IWidth of trench.___-. 14------------------ Seepage Pit: Depth of filter material------Al?";, --- Distance to nearest well JTofal length----------_g(7 ------------------- Numbeof ----------------Distance from 0A dation_____ -------- r pits-____,(-------_ e12 f, d ' 'n---------- le -----_Lining /,44fw Distance to nearest lot line Cesspool: Distance from nearest well ng maferial__,_0%Pz,6 _Size: Dia Depth--- P -------------- I:s -------------,- Size: from founclaf;on------ Lining material .01----------------- Size: Diameter - -' ' '—41.1= 7 Privy: I -----------Depth ------------ ------------------------------------- a e I---Liquid Capacity- -------------------------- Distance from nearest well___--_-_--_ ------ -------------------------- A gals, Distance to nearest lot line____-__- Distance frorn nearest bui;ding------ Remodeling and/or ;4 V��, ------I------------------------------------------------------------------ rePairing (describe):--------------------- -------------------I---------- - - ------ -- -------------------------------------------- Laz,_Zer`,��------------------------------------------------------------ -----------------------------------I----------------------------- ------------------F---------------------------------------------------- - ------------- --------------------------*--------------------------------------- ------------------------------------------ ------------------------ ------------------------------------- 1-----------*---------------I --------------L----------------------------------------------------------------- -----------------------------------=---------------------i- PP - ---------------------i----------------------- I hereby certify that I have prepa'r'ed this applicafion and that the work will be done in accordance-with San Joaquin County ordinances, State laws. and rules ands, of fhe- San Joaquin Local Health DisfricPz ------------------------------ (Signed) ! ,. I ---------- ---------- I ------------ ----------------------------------------------- By:---------------------------- ---- ----------- nfracfor) ------ ------ (Plot plan, showing size of lot, location_ system in relation to wells, buildings, efc., can be placed on reverse s--------------------------(Title)-----------4� I -- ---------------- ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWEDBY-------------------•----------------------- -------- ---- ----------------------_----------------------------------------------------------------------------------- -- DATE------ ------------ BUILDINGPERMIT ISSUED DATE F�----------- - -------------------------------------------------------- DATE--- -----�?- f Alterations and/or recommendations:----- ---- r ---------------------------------- --------------------------- -__ --------- -- ---------------------------------------------- -_-------- - ------ ------------------------------------- ---------------------- ---------------I -------------- --- ---------------- --------------------------------------------- __0_4 ------I---- ------ P--------------------------------- ------------- ----------------------------------------- ----------------------------------------------------- ---- - ------------ - ----------------------- ------------------ .... ---------------------- -----------------1-------------- FINAL INSPECTION BY:_-- -- --------------- - --------- ---------------------- Date Date-- -- 27 t _/ --------- ------- ------ ----------------------------------- 130 South American Street SAN JOAQUINILOCA EXLTH DISTRICT 30D West Oak Street ' 14- Stockton, California r Nt132NSY..-"�treef �j j more S Lod[, California Manteca, California .814 North "C', s+re,f ES-9-2M . Revises 1.57 FRCO. Tracy, California