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vr` vrrIl_r U,)t: /D, APPLICATION FOR SANITATION PERMITrmit No.(Complete in Duplicate)------- This Permit Ex fires 1 Year From Date Issuedte Issued -_7__ �b 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 It County Ordinance No. 549. IDS VV JOB ADDRESS AND LOCATIO__ _ . 4 ! Owner's Nam - lt' __ �2� - ------------ - ---- - — - �f ------- - ----- Phone----------------------------- Address__-______�----- � / -------------------- ' --•-------------------- Contractor's Name----------------- --- 7'�Ao,,e ----- ---- ----- -- ------ - ------- ----•--------------- ---•-------- Phone-----•--•---•----------•-•--------• Installation will serve: Residence Apartmen ❑ Commercial ❑ Trailer Court ❑ Motel Number of livingunits: -___ __ ❑ Other Number of bedrooms ____!/Number of baths --___�__ Lot size •l�-_- _.- :" ❑ Water Supply:I : Publics stem y ❑ Community system ❑ Private Depth to Water Table l Hapan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam Cla Previous Application Made: Ilf yes,date__._-------- } No New Construction; Yes ❑ ,No y ❑FHA/VA: Yf Adobe❑es F3rdNo C] r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public F P p l-ewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well---- Distance ' K Distance from found� 'on__.-.__ ----.-.Material__-.l____-". a No, of com artments- '( f� 4 a p ��, f t . p Size - �Li uid de th Capacity-� C'r Disposal Field: Di tante from nearest well - C� �� � }/ I -_ _-._Distance from foundat.ron- �- - Distance to nearest lot line_-_" ____.___"- m•ber of lines--------1- �-�I r - 1 _ - /t p _._Length of each line---- Width of french Type'of filter material_�_1_.) .Depth of filter materia Seepage --------- Total `"" Total length------ - -------- ------------ - ------- Seepage Pit: Dis#a�,ce to nearest well_"--_--"_�_-__--"____Distance from foundation_-____-_ I. - --_-.---_-_Distance to nearest lot lint _ - -------- Number of pits--"-------------------Lining material---------- --.___.___Size: Diameter------------------Cesspool: Distance from nearest well---- .-_---Distance from foundation--------------------Lining material-------- El Size# Diameter-_-.-- --- ----- -- -------Depth- ---------------------------- --- - - --Liquid Capacity _ ---- Priv _ gals Y: — Distance nearest well'_.-_- _---_-- -------- Distance from nearest buildin Distance to nearest lot iine'1 ---------------- - g--------- -------------- -------- `• I { ------------ -------------------------------------------------------------- Remodeling and/or repairing (describern _ ----------------------------------------- ----- l -- "_--___-. " _e -_" . --"__ - .. - ---------- ----------- -----•--_-----------------.----_--._-_-_-_- -----_------_------------------- ---.-.-_------_--__-_----. - _ I I hereby certify that�l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an •rru�lles and regulations of;the San Joaquin Local Health District, ' (Signed)I Cf 11- ------------ � ✓-- �! GI 7/ C/L47 .:cam � n� -------- - -------- --------- ------ -�-�� - - - -----(Tit --- - ----- dPo�Contract w le)-------- --- _ or Pot plan, showing size of lot, location of s ste lati9n to we is buildings, etc., can be placed on reverse side). --- ---------- -- "FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYREVIEWED BY ___" ---------------------- ----------- ----- -------------- DATE- ---------------- ---------------------- DATE_BUILDING PERMIT ISSUED ��- Alt ----------_ --- i---G DA-TE----- ...era sons and/or ret endations:.-------- - -- ------------- ----------- ---- ----- ------------- --------- ----- -------- ---- -- -- ------ ----------- --- -- --------------- ----------------------------- ---------------------------------- ------------------•- FINAL INSPECTION BY:------ �.-- - ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasefton Ave, 300 West Oak Stieet 124 Sycamore Street 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P,C O.