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Z10 o APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _1547-L. Date Issued ---- 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION___-_-:__ .. ............... Owner's Name------- ------------ ------------------- -—f---b--------------tr04_;R.1_" — Address------ ----------------------------------------------------------------- ------- one. --------- -------------------- /_aca --— ---------- -2-or-—----------------------57 -------------- ------------------------------------ Contractor's Name 5i Installation will serve: ResidenceHouse{[] Phone__Id Apartment House E] Commercial E] Trailer Court E] Motel --- -- -------------- ❑ Number of living units: __ J1r El. Other 1___(m�er of bedrooms ?------Number of baths /____ Lot size Water Supply: public system/K Community system [-] Private El Depth to Wafer Table A 6?3--------- ------------------- 00 ff. Character of soil to a depth of 3 feet: Sand [_1 Gravel [] Sandy Loam E] Clay Loam Ej Clay 1-1 Adobe Hardpan Ej 0 FU/ FHA/VA: Yes E:j Previous Application Made: Yes E] N New ❑Construction.- Yes E] N N TYPE OF INSTALLATION AND SP Cl Nom No 2( E F!1)CAfbNS: No sbpf ic tank or'cesspool permitted if public sewer is available within 200 feet) T T, Distance from nearest well----------------�Distance from'foundafion--------------------Material No. Of compartments------ Liquid dep�h -----Size-------------------------------- --------------------------Capacity-,------ Dispos id: Distance from nearest well. I f --------------- 4 i ---------- D;stance from founclaf�ion------- Number of fines-__-_r--- l--`---------------- ------------Distance to nearest lot line_______.--__.___ Type of filter mateial-4--------- -----Length of each line-----------------------------.Width of pe -------------------------- -- ----------Depth of filter material____.______" Total length Seep Pit: Distance to nearest �el)__ /00 V_ Di 7 .0 .10�, --------------- - - r In foundation-V---------------Distance to nearest lot line 477 Number of pifs----- - -------Distance fLo C --- -------Lining material---- 60-61C__Size: Diameter____._._ ---------Depfh—oo�:: ------ ol: t�-- ------------------- Distance from Distance from neare'sf weiI_'____' sfan6e from foundation_._.____ 0 Size: Diameter ----------Dil ----____Lining material------I------------------- ---------- ---------------De�fh------------------------------- Capacity- --------------------------gals. ------------ Privy: Distance from nearest well -------- -----------Liquid Capacity- --------------------------gals. ❑ Distance to nearest lot lire ----------------------------------------Distanc 1 6 f om nearest building------ ---------------------------------- -------------------------------------------------- Remode)ing and/or r" re_p-1a---ir--i-n-g-- -- <---------- --------------------------- -------------------------- ------------_--_--7---�-- 0 1� - I ---- -- --- ----------- --------- --------- ---------- ---- --- -1------------------ --- -------- --- ----------- C -----------efe4r-5--------------e ---------------------7---------------------------------------- ------ I he're6i-certify fh;t I havrepared this ------------- Pplicaflon and the work will be done in accordance--with--San--J-o-a-qu-in--C-o-unfy- ' ep ---- ------------------------------------------------------------------- ordinances, State laws, and r0s)and gulaflon of A San Joaquin Local Health District. (Signed)-. ------------------------ - ---- ------- ---- --i------------------ (Owner and/or Contractor) By:-------- 171� - ---- ----- ----------- ------ --(Title)--(------- (Plot plan, showing size Of lot, location of sysf6m in relation to wells---�� -------- I gsrin a , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------`f C7 --------------------------------------------------------------------- - DATE-------- y BUILDREVIEWED BY------------------------------------------------------------- -------------------------------------------------------------- DATE ING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------1�........................ Alterations and/or recommendatioLDS:_ - -------------------------------------------- ------------------ ---------------------------------------- r------- A------- ----------- -------------------------- -------------------------------------------------------------------------- - ----------0, -:. -----------W. -7 ------------------------------------------------ --------------------------------------------------------- ---------------------------------------------------------------------------------- ---:;.y!n- - --------------------------------------------------------- ---------------------------------------- ----------- ...... ------�----- - ------ -- -- - - -------------------------------------------------------------- -------- ------------------------------------- ------ --------- __- ------------------------------------------------- ------------ ---- -- ------ -- ------- - -------------------------------------------------------- --------- ----------------------------------------------- FINAL INSPECTIO t 4.0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree'lf 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cal;foenia Lodi, California Manteca, California Tracy, California Reviseci' 1-57 F.P.Co,