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APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued This Permit Exeires I Year From Date Issued <br /> Application is i" henw , made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ~ <br /> This application is made in co,�p||once with County Ordinance No. 549. <br /> ^ " <br /> J{}W ADDRESS AND L[> ` ;_2.-!31 <br /> �� ��_ � �- -�-.- --_ - � <br /> Owner's Name--'='����--�i��A��jVJ����=-_-___------'---.-----------.-_---.. 74 <br /> Ad6nss---- . ..---_------.---''''----'--------''''--''''-----------'--------'---' <br /> Contractor's Name. - �� ` - - '--.--' -----------------------------------� <br /> —' <br /> |n�mUmt�nw0wervm -- . ro~menz�| [] T/ |�_ Court [] Motel [] Other 0 � <br /> � <br /> Number of living units: Number of bedrooms Num6er of baths Lot size _ 6-- - <br /> Water Supply: Public system 7 Community oyoh,m [] "^^re [ -Depth'to Water <br /> � Table 71 ft <br /> Character of ooN.fw w depth~of 3.feef: Sand [:] Gravel [] Sandy Loam C] (�|uyLoam [] Clay [] Adn6em�^~Hmndpan �� <br /> -- / <br /> Previous Application Made: UfYes,date-------------------- No [] New Construction: Yes [] No [] FHA/VYk' Yws F] No [-I ' <br /> TYPE OF INSTALLATION AND,SP' |F|CA?IONS; ` <br /> (Nm septic tank or cesspool permitted ifpublic sewer ipavailable within 200 <br /> �009eafJ <br /> Distance fr�m neop:a+ vo||..NTP��.Distance ,��n foundation----- <br /> ---mSeptic . = -- ~ No. of'compurhnonts---.��---Size- _Liquid Jmp!h_-1 <br /> --Cupucity...pe°~ <br /> ` <br /> Disposal F|a|J: Distance from namnuo+ well-----------------Distance from foundation.....1-------------Distance to nmumot lot line................. <br /> 171 Number dfllinat.........-------------------------Length of each line--__—__.—----Width of trench.................................. <br /> Tvou of filter material� ''-'''-'-'Doo+ of fil^ +w, material '-----.--''-Jofu| length----------------------------------- ....... <br /> Seepage Pit: Di ~- ce to~nem,*st well------------- <br /> --------Distance from foundation-----'-.----------- <br /> � <br /> +o nearest �� |�e-_--_ <br /> [] Number of material ----.------Size: Diameter.----------_---- Dept 6--- --.--_-----' �u . <br /> : Distance 6om nearest well -----Distance from foundation-----'--Lining material----_----.__.- " <br /> [] Size' Diameter'--''_-''-''-_'Depth-''--'''-_''-'''-'-_--Uouid Capacity----------------------------gals. - <br /> Privy: Distance from nearest'well .------- -----------------------Distance from nearest building------------------------------------------- : <br /> Cl Distance to!noo,e, lot |�a------.�----_______________.________________._.___ D\ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------- .-------.---'_.__--_--- <br /> '--'-'--'''-'--'-'---'---'- -''------'--------''------'---'--'-'----'---' <br /> > <br /> | hereby certify that I hmveprepared this ' mfthe wnr will be done in accordance w�hSan Joaquin '��untp � <br /> �r6�mmnceu. State laws, and rules and reguhmHmmsnf +he'San Joaquin Local Health District.District. — <br /> ~� <br /> ;�a on to wells,'buildings, etc., can be placed on reverse side). <br /> ...... !m'in <br /> (Plot plan, showing size of lot, 1��c�ai�ii.nl .f ysilw �inr, <br /> -�� <br /> FOR DEPARTMENT USE ONLY <br /> � � . <br /> APPLICATION ACCEPTED BY-.`�.^.-���w��i-��-----.-------_.----.-_.-- DATE--..�-��'�t'�1p.�._.-------.� <br /> REVIEWEDDY------------------------------------------------------------------ ---------------------------------------------------------- DATE--.---------.__-.-_____.- <br /> BU1LD|NGPERMIT ISSUED........I-------------------------------------------------------------------------------------------- DATE--'_._-.__----''-.—._._ <br /> Aheration* mn6/wr ,mp»mmmnendafonu:----..`---'`-----'-----------_----...'.'..----_---_-._.-----------------�........... <br /> ------------------------------------------------------ ----------------------------------------------------------------------_.........-----------------------------------.-- ------------------------------------- <br /> ---------------------------------- --^---'---''_''-�''-''-_.---''_-'- ---------- _.-----------`--_--'---'--_.'''-'----''--.-''-- . <br /> ._---_-_-------.__---.—.-----------__-----__---_--'-----._--_--'--'_—_�- ~� <br /> -------------------------------------------- ------------------------------------------------------------------------------_---_-------___-----------_-----___��__�___��_��_�_�� <br /> . ' <br /> ^ <br /> FINAL INSPECTION 8Y�''(�^- --------------------------------- Date........ --'''- <br /> SANJOAQUIN LOCAL HEALTH DISTRICT <br /> � <br /> 130 South American Street , inwWest Oak Street 1y*Sycamore Street o0xWest 9th Street <br /> - <br /> Stockton,California � Lodi,California Manteca,California r=q:y.Canfo=ia <br /> = ° REVISED ~= *w 5-6t ATLAS � <br />