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FOR OFFICE USE, F: • ______________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. -------------- ------------------- - - (Complete-in Duplicate) • ------------------ ----- -----------_.....-_..-.-.------- This Permit Expires 1 Year From Date Issued Date Issued 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 compliancelwith County Ordinance No. 549. JOB ADDRESS ANDS_CK CATION" -*ZLOO S---------ISD R_I Po r� �p � �� 1 �'° Owner's Name------------- --------- A NO-E- _ ff-E l "' - Phone Address--------------------60 5�-------T O ERR----•--•_Dp------- M- C ----•- ------------------------ ...........-------------------------------- Contractor's Name_ } I '-- ---•----------------------------- ------- -- -- ----------- ---------------------- ------ Phone-----------------------•----------- Installation will serve: Residence :7.Apartmeht House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: Number of bedrooms -:3--- Number of baths__. __ Lot size ._.A—C--R ��._--- Water Supply: Public system ❑ Communit;;� sTe El Private Depth to Water Table _ ft Character of soil to a depth of 3 feet'• Sand Gravel ❑ San y Loam El Clay Loam E:1 Clay El Adobe C-] Hardpan ❑ Prevto us"Application Made: llf yes,date___________________ J No New Construct* n: Yes �lo ❑ FHA/VA: Yes No El � 11A0 E.D f N, __;._T.YPE_OF.INSTALLATION,AND,SPECIFICATIC)NS:. . �( P s p p rFettedeif public is-available within 200 feet No se fic tank or cesspool e p ) Imo" p = Septic Tank: Not n compartments-. � �} 3iwe f foundation- �+0_-.--_ -. tali l e. T�---"---___. p - encs_.-�____��,-_Size__-1�x� _T .Liquid depth _ � 2..,,.:"Capacity---/.ZOP Disposal Field: Distance from nearest well ..J ___._Distance from foundation______(,_..._.Distance to nearest lot lme___�-_�_-----_.-- �� Number of lines- 1.....rL ....` +___Length of each line-_. _ �___r� Width of trench._.p1_ _�.�________________ Type of filter material_. .. __C __ epth of filter materal___. Q........ .....Total length 9 ----- u-------- Seepage -------- p g I I __Distance to nearest lot line___ t_f. See a e Pit: Distance to nearest well......................leis#ance:f>ocn,folfnd _tion__________.__ ❑ P .I g ....V.f �,.,,,.�• jP._..--�"""�" � ------- Cess ool: D st n ------- Distance fromsnearest well Linin- material from founclat on Diameter mm material h.__.....__._ ------------------- q 9 ❑ Size: Diameter_ _ ----------__ ------------- Dept -------------------------------- - X_Liquid Capacity-------------- -------------gals. Privy: Distance from nearest welly _......... _Distance from nea e' s b ilding ----------------------- ❑.;€. Distance to nearest lot line ---- ---------------1... . ------------------------------------------ -------------------------- - - ` ----" -------------- --- Remodeling and/or repairing (describe):-- ------ ------j-------...�..�.._-.--•---------------- ----------------- --------------------------------------- R . -,-------------- ��t ��--------------- '�^-0-------- -J_rev-�--_------------------------ �--------------------------�--------------- -----.- � . ------ - ------------- ------------- ' ---�-------------------------=------------ ------------------- I hereby certify fW.l have prepay this application a nd thatyy��the work,wrill �e done i ccordance with San Joaquin County ordinances, St te, la s, and rules and regul4tiox,.of the San Joac ilin Loel.7HealfA District. _90(Signed)f y"�'�L( � w. ----------------- Owner and/.or Contractors -B ---------------------------. T +_..—.. = = -= ------ (Plot --• .:.. - ------------ ---------- t (Plot plan, showing size ofslot, location,'of,system in relation�to wells, buildinjs, etc., 'can be placed in reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED D BY- 1 R- t - '------- -` ' ------------- DATE REVIEWED BYt----------------- `- — -- DATE -- ------------------------- BUILDING PERMIT ISSUED------ �.'f.z-�� ----P13_06W�-P5--=-'_---------------------- DATE---- -- .------------------- ------------------------------ Alterations and/or recommendations:...�PH ....k�......_i35yc� ,._.-Eo1 _- -_SP> __ter--cR-vu- -:. -------------------------- ------------------------ --- ----------------------------- - ---- s- - ------------------------------------------------------- ------ ------------------ . .--- . ------------------ - FINAL INSPECTI --------- - Date----------3 = s -------• - SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Harslton Mi. 300 West Oak Street 124 Sycamore Street 20,5 West 9th Street f Stockton,California Lodi, California f �.Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press , I fi