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--•--- ------ ------ � . ._ -------- APPLICATION FG, SANITATION PERMIT Permit No. (Complete in-Duplicate) (� // --- ----- --------- ------------------ --------- --------- This Permit Ex 0 ires T Year From Date issued q� O r �/�/ {/-5 2 rC� Date issued ----__--- --- -- Applicafion is hereby made to the San Joaquin local Health District fora permit to construct and install-the work herein d This application is made in compliance with County Ordinance No. 549. escrbed. t • �Pont Owners Name '�I D ...... `----' . JOS ADDRESS AND LOCATION_ ......SANTZ�S r � ;= t - ----- -=------------ ------- -- -- --------- ---------- -_------------------ - Phone----- — Address----------------�T�--•----�.� �0:��.'------��-�--�---- ------�-�.�:_•��!�'.`-----=----------- Contractor's Name-------:_.•Q{r1/1�1E� --- Phone---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailed Court ❑ Motel ❑ Other ❑ Number of living units: t" Number of bedroomsNumber of baths _Z- Lot size __.1C .Ir± r -_ _ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table J-57—ff. 1�3 Character of soil to a depth of 3 feet: Sand Gravel ❑ SandYLoam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ �� Previous Application Made: (If yes,dcite---------------------) No �New Construction: Yes No ® FHA/VA: Yes ❑ No M— TYPE OF INSTALLATION AND SPECIFICATIONS: /\ - [No-septic;.tank_orrcesspool-permitted.,ifrpubiic-sewer._-.is,-ayailable within Septic Tank: Distance from nearest well---5Q --Distance from foun ation_ -0-___ .-__.Material__ C1D/V J 7` No. of com artments_ ._ Z.� p ----- --&ZOK 1�,= _ _ Liquid depth---_ �------Capacity--- Disposal Field: Distance from nearest well._5©_-..__Distance from Woundtion___--_ :. ______-Distance to nearest lo}Number of lines____--_____�- Len th of each -:_ rr r g -- ------ -•- Width of trench-•___--- -- � �r----- �-- Type of fitter material-__fS_Q / _ Depth of filter material ___ Total length --- lip----- �y Seepage Pit: Distance to nearesf well------------------------ from foundation____________________Distance to nearest lot line______-.___.__-__ G ❑ Number of pits---- -=--------------Lining material_ _-;.---• . -Size: Diameter_ =------Depth------------- ------------------ Cesspool: Disfance from nearest well_______________ _`_Distance from foundation ____ Lining material__.______.______...______.._ , .: ❑ Size: Diameter------ Depth Li uid Capacityg ---------------------------gals. q Privy: Distance from nearest well...._______________ _ -_.____Distance,from�nearest build;n Distance to nearest lot line______ � • Remodeling and/or repairing (describe):_- --- ----------- _--f y ---- - ----- r �... -------------------------------------- ----------- 3 -------------- - .' _-� ------ -----------------��--�------ ��: h� H�--------��^"� ��-------------- I {�D -------------- -------acv Isn N 17 - ---------------------------------------------------------------- - =_ .-�t=R-_- - Thereby certify that I have prepared this application and that the work will be.done:,in accordance with San Joaquin County sa• ordinances, ate laws, d es and regulations of the San Joaquin Local Health District; (Signed----- -----:-----•- ---(Ow - (Owner and/ar Contracto ) 8.�: :�- .: ... _ . yAl --- �--.--- --„---.---------------------------------------_ - {Title)------ - r (Plot plan, showing size of lot t location o s# stem in relafion to wells,buildings, ets., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......71i_-r'�_.-©------------------------------------ ` 2�6 DATE - '--- :-...-- 5--------------------- REVIEWED BY- ------------ ------•---- ---------� - ' .. ------ DATE-------- ----- - ILDING PERMIT ISStJEQ ---I------------- --- --------•-------------•- ----------------------------- ------ DATE----------- --------- ----- ` Alterations and/or recommendations:-_ ________________ _ _ `---- I -----•--------------•--------------- ------- �- ------------------ ----------------- -------- ---------------------------------------- --•------ ------------- -----------------------=-------- ---------------- --------------------- --- - ------------------ - -------------------------- FINAL iNSPECTION�BY:_ __7 . .....Gr? U S v Date ------- -'---------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ^:} Stockton,California Lodi;California Mantecar California Tracy,California - . r_—_. r`