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FOR OFFICE USE-. ------------------ ------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ---------- ------------ ------------- ---------- --------------- (Complete in Duplicate) Date Issued -- "--- .---_- --------- -- This Permit Expires I Year From Date Issued permit to construct and install the work herein described. Application is he-r4eby made to the San Joaquin Local Health DistrictfT� . � 0`."549."'"'"ftw� This application is made in compliance with County,GMinanc W P--- 1W C. 15-5 19-9 > -- I-A-FHR . j - F 16700 - ' It-. I-, 1>--------RD------------ JOBtKIDDRE ------ -------------------- --- ---------- �§IAND'F08ATI�ONIP6— R- ------------- ------------------------ -- 8 1 ----------------------------------- Owner's Name---I-----V-1-0.4-A----------ROJFJS-----L - - -------------- Phone 13coll a-P lk-------------------------------- ---------------------- ------------ -- - ------`---f--•-------------- Address_.--------R-m-E-=/-—------- --------- " ----- Phone-------------------------------- Contractor's Name---------40-miN- ------------------------------------------------------------ -------------- 10 -------------- ------ Installation will serve: Residence Ej Apart tent House [] Commercial [:] Trailer QOA�Motel [] Other E] I I I Lot size �- ./ys-+=—------------------- Number of living units: ---- NumberV bedrooms -12".-- Number of baths ?------ Water Supply. Public system [I Community system Ej Private P--Kepth to Water Table-/49. ft. 1 0 �4 Hardpan C] Character of soil to a depth of 3 feet: Sa'ncl:ja--G ravel [I Sandy Loam 0 Clay Loam lay [] Adobe [3 ---N- - --�,HA/VA: es E[ Previous Application Made: (If yes, a ---------- No ew-Con0ruction: Yes o No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T. q.�e from foundation--./P.!.��Material--RJE;D-VVO<)-t>--------- Septic � ---- Septi nk: Distance from nearest Ir A 2 111 Liquid depth,/,�- ,*---------Capacity----- No. of compartments..-7,-----------------size_-, Disposal Field: Distance from nearest ell %5------- --Distance from foundation---/4---- -----DistaL to nearest lot line--��-- ------ 9V - vidtO of trench._.--- --------------------Length of each line---- Number of lines___" X. ----------X----- Type of filter m a- -�k -0 Y) aferi O-Cf�- --Depth of filter material____ __4 Tcl'�al engfh------------------IT j �l Distance to nearfst well----- ----------------Distan(�e from foundation---_____-_- -..___.Distance to nearest lot line---__..._______- - Seepage Pit: ir1r, Si # 16 1 .Depth------ ------------------------- 3 0 Number of pifs----------------------Lining material---------- ------------ ze; Diameter---------A........... Cesspool: Distance from nearest well- ---------------Distance from founcation--- ---- A Li'in material__.__....___--.___.__.___._--.__._. Size: Diameter Depth quid' Capacity-.---------- gals. Privy: Distance from nearest well---------------------------------------- - ....Distance from r.a"� b ilding.-------- -------------------------- --------- to Remodeling and/or repairing (describe):---' ----------- ------------------------ 0 Disfance-oto nearest lot line--------------- ------------- -- - --------- ------------------------ --- --------- y ---[&Wrh ---------------- T- H-1.5--- -----KA. I Mqf�gm 14-6 T- cro-----T-HAOVG14--- ----------------------------- C-P w -Vi;:W.N-7-) FkQ-4 ---IYTA —---------- VAR I-------B-Wr�---J.,90i Is-------Ul . U I 0 ince with San Joaquin County�herdlsy. .',certify. that I have prepared this a licafion and that the work will be done —11CIria I 1 11 ordinances, S a e laws, rl d iregulafio of the San Joaquin Local Health`District. 4-v '((XN�ner ind/6ir-C6ritir-ai�F6F (Signe )------ -----X12 .---- ---------- --------------- ----------------------------------------------- ---------------------------------------- -------(Title)------------------------------- -------------- - --------------- By:------------"J A --------------- IL `** wells, buildings. etc.. can be placed on reverse side). (plot plan, showing size of location of sysfem;in relion to it N FOR bEiPARTMENT USE ONLY APPLICATION ACCEPTED BY------. F- ------------- --------------------------------- -------------- DATE----.- -------------------- ------------------------------- ------- REVIEWED BY--------------------------------------- ------------------------ DATE ------------------------------------------------------------ BUILDINGPERMIT ISSUED-c;`m`m"e--nZl—at---------- ----------------------.-----I------------------------------------------------------ - Alterations and/or rec - ......... . .....11�--------------------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------------- ----------------I-------------------- -------------------------------------------- ------------- --- -------------- -----------I-------- -------------- ---------------------------- --- ---------I------------ ----------- ------------------------------ ------------------- ------------------------- ------- -------------------------------------------- f ------ .... -1----- ------------------------- --------------- - --- ------------------------------------------------------------------------------------------ ----------- ------------------------- ---------------- --- -- ------- ------------------ ------- ------------I---------L---- -- -- --------------- - -------------------------------------------- -------------------------------- - ---------------- ---------- - ----------- _77 ------ - FINAL INSPECTI Y D-ate % SXN'JOAQUIN'LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.1013.