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t oLICA FOR SANITATION PERMIT Permit No. ..... 1_.__ " - [Comple+e in Duplicate) Af .1+ 'Z Date Issued --- 1pplica+ion 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 inj�compliance with County Ordinance No. 549. JOB ADDRESS AND LO TION 4 --------- -- _'___._- '____"7`- �______ -------------------------•-- -------------------------•-------•---- a �- J ia, Owner s Name------ ----- . . •• •..-- Phone Address-- �7 ----1----------� . -. - `' Contractor's Name------------ -----• Phone-`-1---=------------------------- - iIM Installation will serve: Resli�encu Apartment House E] Commercial ❑ Trailer Court ❑f Motel ❑ Other ❑ Number of living units: _� Number of bedrooms _�__ Number of baths _�____ Lot size _C�_.9_ __ _____% ____�__ _ ------------- Wafer Supply: Public systlrri� Community system El Private ❑ Depth to Water Table ________ ft. Ih r ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No`� New Construction: Yes�No ❑ • ` TYPE OF INSTALLATION�IAND SPECIFICATIONS: (No septic tank or cesspool sspool permitted if public sewer is available within 200 feet.) Q Septic Tank: Distance from nearest we -AZSDistance from foun_datian"-J�..........Material-_- �'��°� _--- r 015 No. of compartments____ � �C_ ' Liquid depth ""_._�-- p "" '' _Size Ca acit r �- F Dis�I Field: Distance from nearest welLX�7.4�.Distance from foundati n----- -------Distance lines--------- of trench.___- r r Type of filter material_ LCA 6�or,kf filter material___ = �-_------Total length___ D,See a t: DI Seep g � to nearest e L ___._Distarice from-4 undationGDistance to nearest lot line----_..___ - �� m of pits------ -----------Lining :material-,&j --.Size: Diameter----------------------.Depth-------------------------------- Cesspool: UU Distance from nearest well-------------_---Distance-from foundation--------------------Lining material--------.------._____-_----_______ ❑ Size: Diameter--- - -=--------------------------------Depth-----------=--------•-------- ---------------------Liquid Capacity---------•------------------gals. Privy: Distance from nearest well___------------------------------------ ---Distance from nearest building------------------------------- ❑ Distan'l� to nearest lot cine---------------------------------- ---- ------------------------------- Remodeling ----- -------------------- p Remodeling and/or repairing {describe):-_._____ ----------- ------ ------------ 11 - _ "'- -- -- - ---- - -- � f�l �L- _ ----------------------------------------------------------- ---------- -------------- ------------- ---- rIh---------- ------ ----- --- ---------- ...... f----- .trt rA .�� I hereby certify that Illhave prepared this applicafion -- d 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. I \I (Signed) ---------- � ` ------ ---- (Owner and/or Contractor) ra`�' 13y:._... G / ------ --- --------------------------- (Title) --------------- ---------------- i (Plo+ pian, showing size of.lo+, location of system in relation +o w s, buildings;etc., can be placed on reverse side). �Ih a t Y tir FOR DEPARTMENT USE ONLY Illl . APPLICATION ACCEPTED BY --------- -- ------ DATE------ ------------------ - - - ---- - -- ---- -------- --------- iREVIEWED BY------------- ----5 ---------------------- ----------- -- - -------- --------------------------------------------- DATE--------:---- ----- BUILDING PERMIT ISSUE ( ISSUED ,----------------------------------- ----- ------ ---------------------- -------- DATE--------- comm " - -, - -- , mo�:---Alterations and/or re ---- --f---• z•J-- i ------------------------------ ..�II�N . ----------------------------------------- ------ ----- --/47 -- ----- ---- -. � ------------- -'FlNAL 1NSPE ION BY]�- --- - -- --�"-'�----- - - - - --�-----" - Date- - 1~..�-------------------------------------------------------------------- t SAW OL y+-C'04'r A �i�U110 LOCAL HEALTH DISTRICT � 130 South American S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, CaliFornie/ Manteca, California Tracy. California w `7,5 + u C5-9-2M 745446 ATWOOO 12