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I ]-UK UP-HCE USE:' G. ....... -------- APPLICATION FOR SANITATION PERMIT Permit No. ,. " A - (Complete in Duplicate) ---- ----------- "---- ---- ------ ----------------- k This Permit Ex fres i Year From Date Issued Date Issued Application is hereby made to-the San Joaquin Local Health District for a permit to construct an�stall # k 3rein described. This ,application is made in. om Pante with County Ordinance No. 549- , Ir _ I.f.�vICOTS. xlbls�q ,/_-tA=j � I JOB ADDRESS AND LO ATIO - FRENC �I • �� ---- Owner s Name________"____ _ -•---- -d. l � - `J�V��PPF --------- -. Phone--- Address------------- - & 3-72-- r -'�----------------••-------------- ----- --� �r Q ----------- -----------------------------------••------ •----------------------- Contractor's Name----------Ser-:,1 ----- ----- �' 3-] _ -:--:---- �.. Phone ` s Installation will serve: Residence [�Apartmen# House ❑ Commercial ❑ Trailer Court�0 Motel ❑ Other ❑ Number of living units: __{.____ Number of bedrooms -3-.- Number of baths _l___ Lot size __ 2$_-X__.-- ------•-----�� ----------•-------- Water Supply: Public system ❑ Community system ❑ Private FT' Depth to Water Table Z Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ O Previous Application Made: {If yes,date--------------._....) No New Construe+ion: Yes �r No ❑ FHA/VA: Yes 2�--No ❑ f TYPE'OF INSTALLATION AND SPECIFICATIONS: (No-septic-tank or cesspool permitted if public sewer is available within 200-feef.)- Septic nk: Distance from nearest well-_511)....Distance from foundation_____) ______.Material- ©f11'C112_E_T� E No: of compa�finents,!" - ar- Size"- -.. . . .. r X/-O_X_�.Liquid depth----Z .v Capacity--- s apacity-- 1 -a-- Disposal Field: - Distdnce from nearestwell. `5_ .._Distance from fou ation------ 0_.._ Distance to nearest lot line. ..----- r � . ' -- E Type u bof filler mayterial_ Q _--.[},e th of filter material_____-f i 'Width of trench__.__sZ f�,i r r . _.__Length! of eat line.___ �]�_ '��"-- ' I 1, g --------------------�5-V------- o ; f -------- Seepage Pit; Distancebeof nearest,.well____.`_- __ _.___Distance from fou dation___.__----- _."Distance tohnea e t lot €ine__-_____-_---.-- ,1 Pits --------- -----Lining material------=---- 7-$4yjDia ;eteor Depth-}- ------------------- Cesspool: Distance•from-nearest well_____:-.._____Distan�te from foundation...._f___ _ �r�r",.-.,;�....� _ _. .f , ----.Lining material--.-- --- - ❑ Size: Diameter__..a_--"___..________"_"-"7 k ------------------- Priv Depth Liquid Capacity--- -----------------------9als. y: Distance from nearest well___._"________________________...__---____.___Distance fram,nearest building_ __ __ {r._ . � -.�,.�,.,.,,.,...,� i 1]. Distance to nearest lot line_____._.. Remodeling and/or repairingm(deseribe _.__ _. '_ • [�13AnlG. 13±1! Fi .� - ----- �-TTS---- P :-e----- el1 -- 1 --- hereb certf -that,, -- RH = .- w" t. y y I have,prepared�this application and that the work will be done in accordance'with San Joaquin,County ordinances, St a laws,and r`lesland regulatrons of the San.Joaqurn,.Local Health District..�....�...•�.� (Signed).-- _ t t . ,- -----------------------�---------- -------------- -- "---- IL Owner an r Contract - --� --------------------_ _ _:__,-- ------ ------------------------------------ _ _ a or - ----- --------(Title}--.�-� ----_-r_ (Plof plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -�`T i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - --- -"---------------------- - �D.ATE..___ �-�- - -- -- - ------------------------------------- - - --- �� --•----------------- REVIEWED BY ----------------------- ------- ------ ----- --- DSP,ATE---------------------------- BUILDING PERMIT ISSUED------------------------------------- ------------------------------- ----- DATE - ------------------------- - HA- -E J°`�-------- R3.` Alterations"and/or recommendations--------------------- ------------------ 7 ----`- • _-_._________.y` .__-_--..__.__.... y� FINAL INSPECT[ 6 = ------ - -- --- -- -- Date--.--- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cfl.