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FOR OFFICE USE: Al y .----------- - � . _. ------ -- ------------------ ------ ___. APPLICATION FOS"SANITATION PERMIT Permit No. I..._.__. ------------------ ------------------- -- (Complete in Duplicate) �,�,,,,, .----:: ,� Date Issued -----___-__------ ._-------_-- --.--_.., • 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 herein described. This application is made in compliance with County Ordinance No. 549. Owner's Name____ D LOCATIO --------------------------------------------- JOB ADDRESS AN7 rr = = --------------------------------- Phone--------------------- - = ------ ----- r1 4 ------------------------------------ : ...------- r - ----- ---- Contractor's Name------ =� � � t ----------------------- ----- Phone----------------------------------- Installation will serve: iResidence Apartment House ❑ Corrimercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: ---_I.-. Number of bedrooms ---Zs-Number of baths ..(----- Lot size ._-f---±--_x:_-------.-----._.._ Water Supply: Public system ❑ ,,Community system ❑ Private [Depth to Water Table .Zaft. Character of soil to a depth of 3 feet: Sand.[-] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ` Previous Application Made: (If yes,date._------ __------..) No .E IJew Construction: Yes No ❑ FHA/VA: Yes [9"�No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I s (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) _ r. e No' n compartments-2 ,-.-.-.Distancetfrom foundation__r9�. -_----_. Mat nal...S- . ........:..................... - ---Size------- °CS �` ��---Liquid depth------. - r -- p y--- - -- Septic Ta k: Distance fromtments._ . _ �-_.. .- _-..Ca acit �l�__. Disposal Field: Distance from nearest well__�7_p._..._DIstance from foundation.._f-P-----------Distance-to nearest lot line_-�./------ dumber of lines,f.�------- -- =---------------Length of each line-_-Fe------------ .--.. -----------Width of trench .y---y----------------------- Type of filter. material-?b--L f A_-.--'Depth of filter material-A------------------Total length/rd- ----------------------------- See`j7 Pi is �nce �ne �� tstan fro fo dat' n1Q __�___ ....Di ante t e st lot la L e a r- 6 Cesspool: Distance from nearest well...............Distance from foundation-.------------_----Lining material_-.--------------------------------- f ❑ Size: Diamete --------------------------------------Depth*----------------------------- --- -----------------Liquid Capacity-.--------------------------gals, I Privy: Distance from nearest well----i--------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot lire-----' ---------- ------------------------------------ ---------------------------------------- ---------------------------- Remodelingand/or repairing / p g ------------ ..1'7.1i�:�t.C- ---------------------------------- ------------------------------------------------------------------------- I -------------------------------------------------------'--------------------------------------------------------------------------------------------------------------------------------•-------------------------------- ---- - ----------------------------- ---------- --------------- ---------------------------------------------------------------------------------------- ----------------- -----... I herebycertify Pthat I have repar4d this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, a - rules and r ulati s of the San Joaquin Local Health District. (Signed)---------------------- ------------ By: -------------- ----------------------------------- {Owner and/or Contractor) w f By:--••--------------------------------•----a-------------------------------------------------Y --------------------------------------(Title)------------- - ---- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R, r FOR DEPARTMENT USE ONLY I ' ''t - % - APPLICATION ACCEPTED BY--- -_-•--•-----�-� �•--------------------- - - -----------•----- ----------- - ------ DATE----- --------------------- ' REVIEWED BY-------------------------------------- ----------------- --------•------------------- ----------- --------------------- --- DATE:='_7-------------------------------------------------- BUILDING PERMIT ISSUED-----------'----- ----------- ----- - -- --------- DATES -------------- a ----- - Alt ati sand or recommendat'ons:' �!�-. . R. '~ iia--i-2a '4�'f' �' = F t ----------------- ------ ------------------------------ ---------- ----- - ' 3 ao _ >� f �frfa-i f��• ''`° � - er�cz � r ---------------- ---- ----0.0--- f ° _ y FINAL INSPECTION BY:---- I ----------- _ Date. 71p-� 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r D. Y f