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�0 4y ` ,. APPLICATION FOR SANITATION PERMIT Permit. I/ Z, (Comple+e in Duplicate) Date Issued.. 1�9 This Permit Expires 1 Year From Date- Issued _ Application is reby made to the San Joaquin Local Healfh District for a permit'to construct and install the work herein This application. is made in compliance with County Ordinance No. S49. c. `-. - 3S-0--3� i j.3 Z S,Ye _ .. JOB ADDRESS AND LOCATION_/4;4, e,/�K -f&0------Ca!'.Yf-I".-11,.c-._40!S,-��/�'-------------------------------------------- '= Owner's Name------ ,Ike-----._...�Azyw-,f-------------•--_----------------- -=--'------------------------- Phone-------------------------- j_ _,.. --�--.----_----�- - - •------ . e Address-......------J.14�-.-,AV-6-4 ---------------------------------*----------------- - ------- ------------------------•--------------------- ---------------- ------------------------------------------------------------------------------------ Contractor's Name------- � .---1k110/G�' ------------------------------------------- --------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - _- Number of bedrooms _- _ Number of bathsr_y_ Lot size -___d"-/7_�G/__________________________-_-- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table !OVft. Character of soil to a..dep}h of 3 feet_ Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,&�Hardpan='- Previous Application Made: Yes ❑ No 2; New Construction: Yes g?"No ❑ FHA/VA: Yes RR--No ❑ TYPE OF INSTALLATION.AND SPECIFICATIONS:. {No septic tank or cesspool permi}ted if public sewer is available within 200 fee}.) i Septic Tank: Distance from nearest w I------.. -----Distance from fgAnda�t,iQn----j� __:__.Material__ -_ __ '� -----. + W, No. of compartments- Size __- � �c'Liqud"cle +h_.._-' --------.-,--Ca acit �_ } ---------- q P P Y "—p-- No. Disposal Field: Distance from nearest, well s.._Distance from foundat'on------------_____-_Distance to nearest lotline---U�--------- Number of lin ----------------------------- Length of-each-lid- ----el--.Width of french.-.2.V'.1--------------------- �A Type of filter;material/,I:jC j_/i_____Depth of filter,material_-./_x-._--------Total length------A3_2�._______-_______- Seepage Pit: Distance to?nearest well------__-- ---------Distance fr`o� foundation-----l� n _ S ____--..Di tate to nearest lot line _ Number`-of pits------�--- ----__Lin ing material----1 � ..Size: Diameter-__ ' --------Depth--- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-_-.._._..--_-_-__-_____.------_.-.-_. ❑ Size: Diameter = - Depth -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------- --------------___--___._---______-_Distance from nearestbuilding------------------------------------------ I ❑ Distance to earest lot line- --------------------------------------------- ---------------------------------------------------------------- Remodeling and/or repairing (describ e :----------- ---------------------------------------------------- ----------•- -------------- ------------------------------------ ------------------------------------------------------------- -- --- - ---- --------- . I ----------------------------------------------------------------------------------------- ---------•---- ----------------------------------- ---------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ I hereby certify that l have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, an rules and-regulations of the San Joaquiri.Local Health District. (Signed).------------ lSPa't� (9hnWzZ3nZFAor Contractors BY:--------------------------------------------- - ---.---�w_- _ (Ti+le)---- ��e�.�L ........................ (Plot plan, showing size of lot, loc n of system in relation to ells, buildings, etc., can be placed on reverse side). € FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED -------------------------------- __ DATE....... - REVIEWED BY--------------------------------------- --- -1----.-Q --- DATE--------------------•- - -- - - -- ------------------ -- ----- -- ---•- -- - - �-•- - -------- -- •------------------------•---------- BUILDINGPERMIT ISSUED----------------------------------------------------------- ------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:.-Sd-P-PFor---45RQVNb-------f_ ,4-Dr ----- ---- ,_____ZnE� r4 Mose [-�--wh'I H-----t/41-;�----------- 1 -------- -------�'RA_D]=. ------Wa5 o -1 am -------- __o�rrL T------ f&WE-�-----t-------- -R:O: ------him-------LATS a. 'PDt T+rt 1 - r Pf r y'� R_fz>-?...---d�1 La- ------ -------------------------- - ------FINAL INSPE&I- ------ Date_- _ / ` ------ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street \20b.West Oak Street +13.2 Sycamore Street 4 814 North "C" Street Stockton, Califo a 1 Lodi; California ! i* 'Manteca;'Gafifornie 4 Crecy, California ES-92M Revised 8-'59 F.P.Co.