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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued .-----,1-,_L__ 7--- 0 P Application is hereby made to the San Joaquin Local Health District t for a permit to construct and instfffl;K�fW' ofQeiejn 6160;bed. h This application is made in compliance with County Ordinance No. 549. V JOB ADDRESS AND L�TIONA &C 1 Owner's Name---------------red 7 ------ -ok---w- Phone----------- ------------------------ ------------------- -------------------------------------------------------- Address-_........ Contractor's Name--------_------- -- -------------------------------------- -- ;Z7----------------------------------------------------- Phone----------------------------------- Installation will serve: Residence UK"Apartment-House__E] Commercial El Trailer Court El Motel [I Other E] Number of living units::-/----'Number of bedrooms -3--- Number of baths Lot size _eW_X_,U_e Water Supply:-Public system Ej Community system E] Private Number to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0--`Clay Loam 0 Clay [] Adobe ardpan F] Previous Application on Made: Yes E]—No [;9�New-Construct ion: Yes Z""No El FHA/VA: Yes F1 No';�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic'tank.or'cesspool permitted if public se%yer is ava, liable within 200 feet.) Septic Tank: Distance from nearest,well---,>d--"',-�ifanc;from foundation-/P 71 t..Material_-__ - ------- ---- No. of compartments- *1—----------------Size----------------------------•---Liquid clepth------�_Z-- --------- - ------ is fro, Disposal Field: Distance from nearest well-re - Distance fr , foundafionJeDistance to nearest lot line----------------- _Number ine----------------- -Number of lines-------- Length of each line----;?!-P-------- -- --- ------Width of trench.---2)"e`------------------ ------------------ Type of filter material___ ---Depth of fiif'er rndterial---,/- -- ---- ----TOtd# Iength_____-Z1 3/42_1 A Seepage Pit: Distance to nea'tesf'well-------��---,.Qistan-ce from foundation------------7_7 -_ stance to nearest lot line_-_----_-__ X E❑ NuAerof pits----------------------Lining material--------------------:--Size: Diameter----------------------.Depth------M. --------------------- Cesspool: Distance from nearest well-----------------Distance from foundaf;on------------------- Lining material--_-_.--__..___----.---_--__-_----__-. ❑ aterial-_--------------------------------- El Size: Diameter-------------------------- -----------Depth---------------------------------------------------Liquid Capacity-------------- f -----------gals. Privy: Distance from nearest well---------------------------------- -------------D�sfance from nearest building------------------------------------ ❑ Distance to nearest lot fine---------------------- ------------------------------------------------ i Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------- \-----------------_------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I---------------------------------W----- -- ---------- --------------------- I -\ -------------------------------------------------------------------------------------------------------------------------------- ---------- -------A----------------------1. ---•---;.----------------------------------------------- ---------------- I hereb, ---------------------------------------------------------------------------------------------------------- y certify th-at, I have prepared this application and that the work wifl be done in accordaAce with San Joaquin County ordinan es, :k State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-i---- ---- ---- e-------, j --- --- ------------------------------------ ------------------------------------------------------------(Owner and/or Contractor) By:-------------------------�-•--------------�---- -----------------I------Z--------------------------------(Title)---------- -------------------------------------------- rSfZ—G04�10—j7 [plot plan, showing , 1i�no-fsYsf_e_r;� � _681%,-buildings location i Iai on �PAR JMENT USE ONLY . APPLICATION ACCEPTED DATE BY------- ----------- ---------- --------------------I 0/ ---- ----- -------------------------- REVIEWED BY -------------------------------------- DATE----------- BUILDING PERMIT ISSUED-------------- 4 ------------------------------------------- ---------------- DATE Alteration a /orcommendations- -------- - ------------------------------- ........... - ------------ -------------------------- ------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------- ----------I.,--------I I I ----------------------------------------------------------------------------- ---------:----------------------------- I---- ---------------------------------------------- -------------------------- ----------------------------- ------------------------------------------- - --- --------------------------•----- ------------------------------------I----------------------- ------------------I—------------------------------ -----------------------e ----- ------------------------------ FINAL INSPECTION BY.---- Dot ------—----------------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycarnore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseci 1.57 F P.CO.