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' S�OFOROFFE SE �3 �^ T ' � ..... - -�� APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ------ (Complete in Duplicate) --------------------------------------------------------- This Per ued Date Issued ......-•c�•C�.-�� m1t Ex fires i Year From Date.:lss Application is hereby made to the cSan�odqurn tocal,Health District for a permrf to construct and install the work herei described. jbis application is made in compliark-e wifh:County Ordinance No. S49. JOB ADDRESS AND ' OCAT! ----------- Fey P4 .. Owner's.Name:_. one Address__:... s 7..:_ ..- ------ ----•- ••-••--------------- Contractor's Name--____-- - �' �,,� - ---- - --------•-- -• -_-.----- -------------- ------- - P one---•--_.---__----•--------•-•-••--- Installation will serve: .Residence [ .Apartment House ❑ Commercial .❑ -Trailer Court ❑ Motel ❑t Other ❑ ,�1 Number of living units: ----J__ Number of bedrooms _ l60 k/ Number of bathss _ ;Lot size --- - ------------------•_...-- -• --=----------•---- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water;,Tabler,P- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay:Loam ❑ Clay ❑ Adobe • Hardpan ❑ Previous Application Made: (If yes,date........ ... 1No Q� New Constructiono ❑ FHA/VA Yes No -1 TYPE OF INSTALLATION AND SPECIFICATIONS: ti (No septic tank or cesspool permitted if public sewer is availabl",41hin 200 feet.) "S, ptic Tank: Distance from nearest welO2_'¢:►4____Distant fro 6undatron�� f NEate rel._ • �j ----------------- No, of compartments_._Z----------------Size __6 Li Urd de th -- � ::Capacity1 Zbo ` 1 s.._ q R Disposal field: Distance from nearest wel�'j.?�'"�_._Distance from foiandafrgn 6' Distance to nearest lot Gline_.`-:�. .... I Type of filter material-__-./��!�___-_Depth gfi filter{material �� r $ otal hl Number of lines_________ __ Len th of each line �_ of trench:.______..F_ Yp p engfh g b..... ---------------- Seepage Pit: Distance to nearest, ell__ -_.._ :Distance mYfpundatrony::.l.1E____ Distance._. to nearest lot Iine..C.� ^� Number of r+s ._-7, _'--.Srzi- ---------- �� Y� :P r Loring materral e: Drameter'3- i Depth Cesspool: Distance'from nearest we€( Distance from foundation Lining material-_..__..________ ____________ ❑ ...Size: Diameter --•---- ---- - -,Depth-----------------------------------------------------Liquid Capacity --------------�qgels. Privy_ Distance from near'es# well------- --------- -----------bistance from nearest buildin r ❑ Distance fo nearest lot line-------------•---------•---.-------'-:__--- . y . I ` Remodeling and/or repairing (describe): ------- ---- -- L . •------•--•-•--•-•----------------_----- - ------ •---- ------ ----- - ----- • = I hereby certify that I have prepared this application and that the work will be donein accordance with San Joaquin County ordinances, State laws, and rules and regul tions of the San Joaquin Local Health District. - (Signed)--------------------••-------------------------- - ------------- - - •------.--�-- ------....-----•:----------------•------------------------•-------`�•--(Owner and/or Contractor) sr• ---- --------------- [T•,+le), --- (Plot pian, showing size of lot, cation of Sys+e `in relation to wells, buildings, etc., can be placed on,reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY------------- = DATE �]J REVIEWEDBY. ---=-=-------=----_------------------------•-----••----------------------------•--------------------. DATE----- Alterations and I rISSUE ---•------------------------------------------••---------------------•------------•----------- --- E.: ------------- BUILDING PERMIT ISSUE � . endations:_ ":.,r�--� - 1 k .. DATE.' , -----------. ......... `�``ac.T .................................>----------------------------------------------------------- ---------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:..---- ----- - Date--------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 Wast 9th Street' i Stockton,California Locil,California Manteca,California Tracy,California t se 9 REVISED a-89 EM 6-61 ATLAS t - moo