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FOR OFFICE USE: _. C.Uv/6�6.fL_ ...............C '.o..o... `r - Permit No. ..(7 � -. APPLICATION-"FOR SANITATION PERMIT _ ....... ...... ................._......:.... ........ (Complete in Duplicate) Date Issued .. �3 ..,.....,...__.- ............................._....... This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin deur bed. r This application is made in compliance with County Ordinance No. 549. / J .................../( ,..:_............_...._.....__............ ...__...__..............._.....' / I JOB ADDRESS AN D-LOCATION....: �. i.... �f!>s�.. :... . Owner's Name ...... v/'i. �.,!- V....._................ .. .. ............... one.. / �........ _ ............................ Address............. !L IIt!/ �. '- .. r ........ ............................. ............. Phone Contractor's Name......... ..! ......... �it�.(flC.l...................... ..i� ,. Installation will serve: Rasidence gi-Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Offer ❑: Number of living units: .. .. Number of bedrooms '? Number of baths . ... Lot size .a ..........' ""' Water Supply: Public.system 13Community syitem ❑ Private I[f' uepth to Water Table m,...J t. Character of soil to a depth of 3 feet: Send ❑ Gravel❑,. Sandy Loam ElClay Loam❑ Clay E] � Adobe Herdpen❑ id Previous Application Made: ;If yes,date..__._ .....a,...I No 2>.,SaNew Construction: Yes kj--'No ❑ FHA/VA:Yes I-4--No❑ A A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if public sewer is available within 200 feat.) ._ �(,.11...Dietane_e from foundation...I;e. ...Materlal..�.�i l!f� � .... Snpiic Tank: Distance from nearest we ( ..,_-___..-Ce ecl .l..�I-' ,rjf( ....Size .c ! .f�'X IL uid da +h._....,'Y..... P +Y ..... n No. of compartments.... +.a. :f't . .. q P. Disposal Field: Distance from nearest welL.v.�G�l,::. Distance from foundation...2Q..........Distence to nearest lot line.Zo......... - -. Number of lines..:.:..q(. . . ..y Length of each line...L �'.----./ -Width of trench.. �..._y.................... r Type of filter mbterial. ;Depth of filter material...I-P.�-......Total length...^lv±c -:(::r-: •� - N�' ry . ....Distance to nearest lot I�e.li�...... r Seepage Pit: Disienca'to rrTsarasf well...//. (�.._...Distance from fourideiion.>�[�.._ J y�� ❑/ Numbcr ni pits Lining material.. .r(l[f ..Siza: Diameter �.Il.............Depih, ir ....yriffir..e.. pi ....:r:.... Distance fronearest well.. ,t...........Distance from foundation..............._...Lining materiel..... Cesspool: .....Liquid Ce act Size: Dineth.._.........._..._..........................-..g... gals. F1er _ ................ Dapih....................................... ..... A e .... ,. _....... Distance from nearest building. ....... .... �c - Privy: Distance from neem•, lin - Distance to nearest f line... / Remodeling and/or repairing.(descrfoe). r.'��td/<!L/ T•�l �"...__........................._..... . . . . ................:.:........................... _....:..`_........_..........c........................................................�................... :i ....................................:.:.........................._...............................:.......................................................................................................................... .............. .........Y......._........ ..P.'p ...9..........PP_............_........q__..................................._........................,......................_................. I hereb certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fate laws, and rules and regulations re .�ullaations of the San Joaquin Local Health District. Signed `�. � ..:��.C.'� 1.(/!/.. ... .. ....._./.. . . or Contractor) .. Title By:.... _. 9 P (Plot plan, showing size of lot, location of systerq i relation to wells, buildings, etc., can be laced on reverse side). i :p FOR DEPARTMENT USE ONLY _ -i C JV G' APPLICATION ACCEPTED BY........../"..1..�. .._. µ... ..........................-_......... DATE......c 11--.......�:...(Z..��...._............ " . ........ . DATE..................."---.................................. REVIEWED BY.........._............._....................._......._.....:........_..........._......................... .....�....-DATE.............,................_........................ BUILDING PERMIT ISSUED..................................._........ . .. . .....................:... Alteraiiont end/of recommendations:...,...:..... "Y' �..i�>.. ilk". .._ .�........ ......................ya...._._.......,..._............................ ......................:..... / I /..a.CST.:/.......;. .LS.._.................................................................................................................................................................... ...........� r ......................................... .................................... !.............. Dal .l ....._. ..__.. FINAL INSPECTION BY . �- -SAN JOAQUIN LOCAL HEALTH DISTRICT - ]00 Wer'Cak strut 124 5ymmere Street 203 Weal Vth sever 1601 !.Mesas,.,Are. - - Celllernle Memrm,Calllernle Tracy,colilomw Stadlen,Colllernla iedl, r e.co.