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FOI OFFICE USE: ......... �..---.----. A,' Lf(P TXT I R FOR SANITATION PERMIT Permit No. . ----------------- ------------------ ------------------- Com fete in Duplicate).�...e.r.,.....,........,....,..,...�c.�,�-. �.�:...:_L__ �.P' .�. . .�.. p� ... } ;_ Date''issued ......................................................... This Permit Expires 1 Year From Date Issued` I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A50CATION-_ _�©_ Owner's Name_ ---0.1M-1--R-_To._•-___ Aq _ - . -------- --- ----- ------ -- Phone------------ --------- •------------ __ Addres • - -•---- k---------- 0Contractor's Name_^__ - _-- - ___-- ------ Installation will serve: Residence partment House ❑ Commerc+al� Trailer Court ❑ Motel ❑ Other ❑ . � ,, EI �'A / � . � pp Number of living units: -1----- Number of bedroo s _Number of 6athsi 1:__ Lot size �Q_�'._. __._�__ . __�l_________._ Water Supply: Publict system ommunity system ❑ Private ❑ j Depth to Water Table�ft: 3 � # Character of soil to adepth of 3 feet: Sad Gravel ❑ Sandy Loam'❑ Clay Loa ❑ Clay ❑ obe 29-`H' n ❑ Previous Application Made: (If yes d e�................__1 No ❑ New Construction: Yes,❑ No 6R FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECyIFICATIONS: (No septic tank or cesspofper7nitted if public sewer.is available within 200 feet.) t Se Ta is once from nearest well_________________Distance from foundation--------------------MateriaL?-------------- No. of c0M artmte ts------------------------Size----------------- Liquid depth----------------- - Capacity-•--------------------- Di al •eld: nce from nearest well.......... Distance from foundation---______-----------Distance�to nearest lot line----------------- .f Number of lines-----------------------------------Length of each line-----------------------------.Width of french-------------------_-_-------------- T4e of filter, material-------------------------D`epthpof filter material--------------_---- Total length__------.__---__---_-_.._________________- Seepa e Pit: D once to �eare�jt well__i�L �s__Distance-from undaton___�__��______-...Distance!to nearest lot line__.__.----._ Nt mber of pits__.:L__.._..._ ----Lining material-_�1�,U d ..+!Size: Diameter_ZZ�_� __Dept h----AS7...________._____ Cesspool: Distance from nearest well----------- ----Dista nce from floundatidn`+s----- ---------Lining material+_--- __------_------------- ___. ❑ Si e: Diameter. Depth ----------- -Liquid Capacity---- gals. Privy: Distance from nearest well.- -----------------------________ from nearest bulldin -g---- --------------------------------- _____Distance ❑ Distance to nearest lot line - ---~------------------------ --------------- - A- Remodeling and/or repairing (desc ihe�`=-------------------- - ------------ tlr -------------------------------- -------------------------------------•-----•--•----------•---•-•------------------- ------—-4 -------------------� — - - ----------------------------------- --------- - � --------------- --------------------------•------------- -------------------- --- ------------ ---------------------------------- S --- ----- ----- ------------- 4 --- ------ -- - - - -- + I hereby certify t 11have prepared this appl- ion n t at the work will be done in accordance with San Joaquin County ordinances, State laws rules=an&regulatfons�- &the S n boa quin L al HIalth District. } 2,1 & (Signed) isE:F f '1"7?:N'K-SERVtU`e----------------- --- ---- ----� or Contractor] By 2915-E,_MinerAve_.-_ H0:6.384- c ---------------{Title}___--------_------ (Plot plan, showing size of lot, location of system in a+on dwells, buildin s, etc., can be placed on reverse side). �`bRFDEPARTMENTr NL�Y APPLICATION ACCEPTED BY..-------- ----------------- ---------- --- -------- ---------------------- DATE---- •r-'r'-f REVIEWEDBY--------- -------------------------- ----------------------------------------- ------------------------------------------ DATE------------ -------------- --------------------------------------- BUILDING -------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE----------------'-------------------------------------------- Alterations and/or rec mmendations:------ _.... ___._ nC - ------------------•--------------- ---•-------•---------------•-------------- - -------- ------------------------------------------------------------------------ ---------- ---------------------------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------- FINAL INSPECTION BY:_............c�1 Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.L;Li. }