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ci 7 APPLICATION FOR SANITATION-PEIZMIT ? ,/,. , Permit No. (Complete in Duplicate) i 1, Date Issued --- 7 Application i, s hereby made to the San Joaquin Local Health District for a permit to construct and This application is mad P *?J, install the work herein described. .in C mpfiance with County Ordinance No. 549. 7 .... .. Owner's Name--------- y-------- C Ay r 0 JOB ADDRESS AND LOCA ION Fey7' ---- -- ------ ----- ---------------- -------------------- Address--------- --------- ---------------- --------- ------------------ Phone F11_;�--- -_ __1---- --------------------------------- ........ Contractor's Name.-.-__--::---- ---- - ---- - --- t ----------------------------------------------------------------------------------- Phone lns+allafion will serve: Residence R�__Aparfmenf House El Commercial El Trailer Court [:] Motel E] other Number of livin ❑ g units: __/--- Number of bedrooms __'3__ ❑Number of baths I- Lot size Water Supply: Publics Ej' Comm'unify system 0:' Private UR--Depth to Wafer Table,'415�e . ............................... Character of soil to a depth of 3 feet: Sand El Gravel Ej Sandy Loamril El Clay [I Adobe E] Hardpan E] No New Construction: Yes Vr.N'o El FHA/VA: Yes El No Previous Application Made: Yes El Clay Loa ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted-if-public -zewer i3-available'within 200,fe�e-�.)-�-----' Septic Tank: -.,K— Distance from nearest w,eil-5-0---------Distance from foundaf;on_/,0_ Material_--CO-Olt-A ------ --------------------------------- -------------- No. of compartments-----:11----------------Si;e-16..X - _ V � r. . _-Liquid depth-------K---------------Capacity/-7 Disposal Field: Distance from nearest w ...... 57sfan�e"fr7m f u�d 0 a on_/d_4,w-_—__Distanre to nearest lot line--- Number of iines;!-------AZ) Length of each line-50- Type of filter m L ---Y0-!Y_CWidfh of..french----�_2_ 1"" �terial---- -- Depth of filter material---./ --------Total length-----/S� ------------------- Seepage Pit: i -- a. Distance to nec�e'sf well----------------------Distance from foundation-_-__-._- - --------------------- Number of pits--' on----------------_.Distance to nearest lot line----------------- ❑Cesspool: pits_____________________---------------Lining material---------- -------------Size: Diameter-----------------------.Depth---------- ------------------------ Distance from nearest well------------------Distance from:foundation_ ❑ ._----------------Lining Diameter------------------------------;-----------Depth------- ------------------Lining material-.-__-----_-_------------------------ Privy: ------- ------------------------:------------Liquid Capacity--------- Distance from nearest well-------- - Capacity------- -----gals. ❑ - -----------------------------______Distance from nearest building- ----------------- Distanceto nearest lot line---------------- ------ ------------------------- Remodeling and/or repairing (clescribe)------------ --------------- --------------------------- ------7---------------- ----------------------------- --------- ------------r----------------- _-_•----------------•--------,_--•----.-_----------------------------------------I------------------- --------------------------------------------------------------I -------------------------- ---------------------------------------------------------------i-------------------------------- - -----------------------I--------------------------------------------------I----------------------- ---------------------------------------I----------------- -----------------------------------------------------------------------I--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws., and rules.and regulations of the San Joaquin Local Health District. (Signed)......f��_ Z V_eA1 P�r te ------------1-------- By:--------------------- -------------------------------- -------------------------- ------------------ ----- ---------(Owner and/or Contractor) (Plot j1�n�, sIioW;ng'Sixe"of_jot.'_Io�caf_ -------------------- -_.__(Tif le.)-------------- ---------------- ings, etc., can i-e-p-IM-c ;on of_�ysf,_;;—mr-10=�lo- e3�onrve�ii�_si:d� e). FO AR ENT SE APPLICATION ACCEPTED BY--__ --- ---c REVIEWED BY ----- ------------- DATE------- --- --- --------- DATE --------------------- U E --------------------------------------------------------------------- -------------7 BUILDING PERMIT ISS ----------------- ------------ -------------- DATE Alterations and/or recornmendaf ions:-------- -- A� B ----------------------------------------------- 4 --------S_ .5--------- -----:7i= ...........------- ------------------------------- E7F----------SK F 77C-44-----0^_4---------6A, ------ , ----------------------------------------- ------ -- -- --------------------------------------------------- ------------------------------------------I-- -----I-------_--------------- ---------------- --------------- -------------------------------------- 6---------------- -------I - ------- - ----- -------------------------------------- -------------------------------------------------------7------- --------------------------------------I-------- -- -------- -------- --------- - ___ _71 ---------- -------------- ----------------------------- ------------------------------------- --------------------- FINAL INSP a-10 Dat --------- ----- ------ ----- ---------- ------------------ 130 South American Street SAN JOAQUIN LOCAL..HEALTH DISTRICT Stockton. California 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California T-Y. California -ES-9-2M Revisea