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.--------- APPLICATION FOR SANITATION PERMIT Permit No. Azo -- I -- ={Comptete in-Duplicate) This Permit Expire; 1 Year From Date Issued Date Issued -------------------•--- Application is hereby ;made to the San Joaquin Local Health District for a permit to construct and install the ors herein - ?—Z described, This application is made'i nc mpliarice with County Ordinance No: 549. JOB ADDRESS A��o ATIO��0-,---RJ_V \ n ,nl ,Y- i- I-_PTI ------- Owner's Name------ ---- ---- K -'- - i-k- ------ -------------------------------------- Phone It r_7--.--'-------- I.Plio^ . - Contractor's Name_,P"jFK:_ one-------- Installation will serve:Residence Apartment House n [ ❑' fCoMercia 9 � Trailer. Co t ] 'Motel ❑ Other ❑ Number of living units. _-.l-_ Number of bedrooms -. Number ofirbaths Lot size _ 1 9 Water Supply- Publics stem �� '" ✓ y ❑ Community system ❑ Private e D#pth to Water Table. - {t Character of soil to a depth of 3 feet: Sand ![ Gravel ❑ Sand Loam - Y I ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_____________------1 No.e/Nim Construction: Yes o ' TYPE OF INSTALLATION AND SPECIFICATIONS { F± ❑ FHA/VA: Yes ❑ No ��. °`-(IVa--septic tank or cesspool-perrriittedyif-public sewer is ®r well av;aiFlable--wIihi n-200---f�-eet:)i— ePtic Tank: istance from nearest ---• Distance from fouI�ion0----------MateNo. of com artmenfis____--�---------- .Size. Cb/-.1-�-/ � �C-- .r�, ----------- Liquid e th------- � �:---Capacity-.19QQ P----- " l Disposal Field: Distance from nearest well___,5 Q . , --. ._Distance f flu ion-- 1Q---------Distance.to nearest lot line---- Number of lines- .I . 'iafih,.of trench9""�_^ T e of filter ma ienal �-G Dpt�of felt ateiial--- - - r f 1` ti otal len #h Seepage Pit: Distance to nearest well----------------------Distance from foundation_-----.--,__-_-.._-.Distance to nearer# lot fine_-----__----_--_ . ❑ Number of pits.-..'-----------------Lining a erial-_----------------._5ize Diameter_-_- -- I ---- --------- Depth... ---- ---------------------- Cesspool: Distance from nearest Weil------------- Dista �frbm foundation---_----------------Lining material-_-.__-_-.__--.___._______ ❑ Size: Diameter i ) `De th '. i�s,� Wit. r� 1 y Priv # 40r� } P - -------Liquid Capacity gals. 1 Y: Distance from nearest well__.._._______________________ {� 1 _--------____._---Distance from nearest building_________ _________ ❑ Distance to nearest lot linelor --- 1 I I Remodeling and/or repairing (describe):------_-_ ----------- ri # ----------- - --------------- ------•--------------------•------ f ----------------------------------- -- __ --------- --------------------------------•----•-•--------•----- 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)-------------------------- -------------------------------------------------- „�_.._„ 8 --- '- _(Owner and/or Contractor �t (Piot plan, showing size of lot, location�of system In relation to wells, buildings, etc.,. can 6e placed on reverse side)!; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---------------- DATE_ ---3.7. REVIEWED BY.------------------------------ -- -------- ---------- -------- ------ ------------ BUlLDWG PERMIT ISSUED. - - DATE --- ------------------- -----•------- ------------------- --------------------------------•-------------------------- ----------- Alterations and/or recommendations:-----/Wr C , DATE_____________________ __ _--_-_ _--- f��411f 1=: = Ao4 _21-------------------------- ----- ----------------'- �. ---- ------ r w.,... ------------------------_�............. ---- ---- FINAL 1NSPEC ' -' ---- -- -- Date --------------------- - - �.- { I SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9}h Street Stockton,California Lodi,California ' Manteca;California Tracy,California F.P.Cp.