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FOR OFFICE USE: ------------------- --- --------------- ----------- a ------------------------------------------ APPLICATION---_-_- FOR SANITATION PERMIT Permit No. ---------- ------------- ----------- -- --- - ---- (Complete in Duplicate) ------ This Permit Expires I Year From Date Issued Date issued ___ _rl�s.__ 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 compliance w',th. Coun.ty..Ordinance No. 549. r" 4-11 p7 „� '- JOB ADDRESS NA L��C EON_ n_MD =-'Z4..---.0 5-�-----�---O- Nl LI-- ----- -- .--- Owner's Name------------ L1-i _}-_�.:�ORF—'-"----------- - Phone Address------------------------_-- >/ Contractor's Name------------ -----. -- t----- *------•------f --------------------------------------------------------------- Phone-------•------••--•----•---•------- Installation will serve: Residence [ITAparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ Number of bedrooms ___ IQ(� �C_-j_ Q---------- ----- �.-_-__ �_-_ Number � Lot size _.-__ __, ___, -__ Water Supply: Publics stem y ❑ Community system El [�De t.h to'WaferTable'_�_/__"ft. .' . ' Character of soil-to �eet11.P3 ��t;..SwA� C�:r�vi n� SAL �a „�, c:A �l� r lr a Ariob-w 'isr�a�rat�'u t Previous Application Made: (If yes,date---------------------] No (j--New Construction: Yes [I.—N-c ❑ FHA/VA: Yes ❑ No?f-- TYPE OF INSTALLATION AND SPECIFICATIONS: (NOrseptic-#artk-or-cesspool-permitted if public-sewer'.is-available•within 200 feet:}” Septic Tank: Distance from nearest well-_.-________..._Distance from foundation____________________Material______--_-_-___-__- k =_ F_e)[UST G- No. of compartments----------------- --------Size--------------_---------------LiqAid de th ------------ ------Capacity ----------------------- Disposal -•----------- -Dis osal Field: Distance from nearestwwelL_ -50---_.Dista fro+m ouadafon-.:_ /Q_.Distance to nearest lot line____17`_._�,r TE fqf r Number of lines_____.___________________Lengf t } 11 _ : > =P:Type of flter mate DephffJ / Seep ge Pit: Distance to nearest well________________ __Dstance from foundation___________ ________Distance rj to nearest lot line-----____.__-.__ ❑ Number of pits_-------------------Lining material-----------------------Size: Diameter-------fi--------------Depth_____-__--_---__._____---------- ' Cesspool: IJ+stance from nearest well-----------------Distance from foundation.......-------------Lining,material_.._.__-__-_-____-__.__________-__.gym,. ❑ Size: Diameter...k°-------------= --------------- Depth-------------------------------------------------LiquidCapacity---------------------------gals. Privy: Distance from n@arest well------------------------------- ---------------Distance from nearest buildin g -------- ❑ Distance to nearest lot e------------------------------- ----- D� Remodeling and/or repairing (describe):_-------------------------------------------- ------------------- ------------ ------------------------ --------------------------------------"``----------------------------------------------------- ----- ' -- ---- --------------------------- - - -�� - ------------------------------------- ---------- ------------------------ ---------------------------------------------------- �- ` ``` { �., %t_ 1 I hereby cer ify a W ve prepared this application and that the work will be done in.accordance with San Joaquin County ordinances, Sta I , a d ules and regulations of the San Joaquin Local Health District. 4 + (Signed) ----- d �_ _._ ` $ t � ► --- - ...... ---- ----- ------------ --{Owner and/or Contractor) a'1 w.....,.r-. SY•- _ :. - --..___ _ :_: '� - Title} ��- ,�-( —..� ------------------ ------------ -- - {Plot plan, showing size of lot, ocationf sytem in relation #a wells, buildings, etc., can be placed on reverse side}. .FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY a ._C� s -4 ------------------------------ --- DATE----- ._., S s REVIEWEDBY- ------- -------------------------------- --------------------------------------------------------------------- --------- DATE - BUILDING.PERMIT ISSUED--------------------------------- ----=- DATE---------•----------- Alterations'and/or recammendatioris:" ' —j --- / 1J 141 --� / S-----• ••-- s - ------------------- -- -------,.' ------------- ----------------------------. , ------ ------- . � - � ,t R © _____________._____--.--_-- ----- ------- __ _ _ ______________________________-------___________________-_-.----------------------- ------------------------ - ____-____..________- -_ Date....---- FINAL iNSPECTIO, I ,wB - -- - ----.-a--- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Califarnia Lodi, California Manteca,California Tracy, California r.P.co. 3