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1�;� �C+ a -- �"'T'r--R--�--�-•.iQ- --tee _ .- � sa•.. ----- ------------- APPLICATION FOR SANITATION PERMIT Permit No. - a 7__8 - - ----- ----- --------- -- (Complete in Duplicate) This Permit Ex fires 7 Year Issued From Date Id --- -- -- -- Date Issued Application is hereby made to the San Joaquin Local Health District for a pe�mi# to construct and install the work herein This application is made in 'co I' nce with County Ordinance No. 549. described. JOB ADDRESS AN[ LOCATI N � �A ` X7vs. C. Owner's Name_ -�. ,� � ? Q�"*R 1Y1 _l ------------- --- ------------- Acddress------------ - :.-- -I-:-- '` Phone ----------------------------- -------------------- _ Contractor's Name---- D�.+4��;��,-------------------------- -.._-.---••--•-----------•----------------••---- ' r ------ ------ "- _o------- ----- Phone-----------•----------------------- =-- - Installat�i1on will serve: Residence �" --- [� Apartment House ❑ Commercial ❑ Trailers ourt ❑ Motel I 'Number of living units: ----�"- Number of bedrooms _- ❑ Other ❑ Number of.baths -- _ # size ___ }G Water Supply: Public system ❑ Community system q �r 1 Y Y ❑ Privateep#h to Water Table :q-_ ff. "Character of soil to a depth of 3 feet: . Sand I] Gravel ❑ Sand Loam Y lay Loam ❑ Clay ❑ Adobe Previous Application Made: (If yes,date-..._- _----- -� E] Hardpan ❑ , . ----) No�'`Ne0 Construction: Yes o TYPE OF INSTALLATIO1`4 AND-SPECIFICATIONS: ❑` FHA/VA: Yes:[ No E] {No'septic fan' cess`cessp I:permitted:` pufihc sewer i"s'availa6le wit tin 200 feet Septic T k: Distance from nearest well-- Q Dista ce from founds#ion- "� E. . Material R. > . p - e` Size- No• of tom artments- _"- _- - ,_ Laquid depth_- -'---- ._ Capacity-----/r ?C?_ Disposal Fi9.ld: Distance from nearest well---- 8_--_Di nce fr foundation---1,�_--------_ �r� Sty Number of:lines-_ --_- --- g o y me Disdhcoft�echrest lot line-•-�, ^ Lel�-��' Len tai f each fc k Tyle,or filter materialt Depth of filter materraf-_ r* ""---""" �r _ - - p 9 ". # ,..-.-... . .,..,�„ ,,, / -Total..length_�--------------- Dist See a e Pit: ante t nearest well_ ---------__-IDiStance from foundation_ El r p Distance to n�arest lot line.--�SO" Number of its__".__-__""_ A Distanceffrom newest we)1 Linin �Dtstanlce from foundation Diameter.__.'-------------- - ppth- ------------------------------- '4A - " 1111 b g Cesspool. t �-� I n -.Lining material--------- ❑ Sue. Diarris?ter"_--- �*"� E Depth - ---_---Dista -- ----------Liquid Capacity ----------- gals. Privy: Distance from nearest well-.-_--_--_,_"--______ ce from nearest building__-__-__--_--___-_--_-- ❑ .. � Distance to nearest lot line �� - --------___"___ -------------------------------------- pairing ---------------------- -- 191 Remodeling and/or repairing (describej:-----"- ____-.__"-----__,__ t � - - --------------------- ----------------------------4------------------------ _ - -- - ------------------------ -------------------------------------- ---- --- V�• _--_-------••---------__-------------_------- • y -- -------------- -_--------- ------------•-`-•-------------------------------- I hereby certify thaf.;P have prepatred this application and`thaf the work will b_e done tri•--"--- - " - - �--- "----•-- -------- --•-".--........... ordinances St to aws, d rules an accordance with d regulations of the San Joaquin Lacal�Healtli District�'�"!` San Joaquin County P (Signed) - --------------------------------- -. .w.n�er and/or r on rat tor) (Plot plan, showing size of lot, locatim ----------------------------------- - , onosystem' En-relafio to wells, buildings, efc.i,pan be placed on reverse side).-. � ( FOR;DE=,FARTMENT.-U E ONLY, APPLICATION ACCEPTED BY_ __77rc _ - --------- ----------------------------------------- DATE------ -------------------------- -- REVIEWED BY ------------------------- 1 ................. ---- - BUIL - ----- ----------- ------------------------------------------------ DATE-------- ------------------- - PERMIT ISSUED ` ` Aiferafions`arl recommendations:- _--___--- - -------- `a'': ATE ----- --------------- Jit-►a .. = = _-:> -------- ----------------- --------- --------------------------- ---------------------------- ----------------- - - T.,y. �. - FINAL- _ .27`" --------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Ha Zoltan Ave: 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,Caia liforn205 West 4th Street Manteca,canfornia F,P.CO. 'f "�- �'ai Tracy,California ,