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FOROFFICE USE- ----------------------------- ----------------------- SE------------------------------------------------------ ' APPLICATION MR SANITATION PERMIT Permit No. ....1... �. ..../ ---------- ------ ------- ------------- ----k-- (Complete in Duplicate} --- This Permit Expires 1 Year From Date Issuedto Issued .... Application is hereby made to the San Joaquin'Local Health District for a permit to cons Winthe work rk here in d�e t 1�b� . ' This application is made in compliance with County Ordinance No.,_549. /,� r r , JOB ADDRESS AND LO ATION : 1 ,"- Owners Na' me- _ -. � rs ' w . o rZ Address 01C. mo ...._ 2 . ....... ne .... .'. - —0 �yf - A ' -�----- - _ --*.........------ Contractors Name- ------------- - 4. Phone-------------------- Installation will serve�: Resi ante El Apartment House.❑ Commercial le Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _!7-_ Number of bedrooms�._�-- Number of baths _I.__ Lot size ---------------LD e......... T _ Wafer Su ty y ❑, Private De th to Water Te Supply: Public system ❑ Communi� - system T p bre -------- ft.- Character of soil to a depth of 3 feet: Sand-''E]- Gravel-F]' 'Sand -L`oim ❑�Clay Loam -[I—Clay ❑ + Adobe❑ Hardpan ❑ y Previous Application Made: 1!f yes,date-------------------- No E New Construction: ,Yes JM No ElFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted..if-public.se-w4 is=arailable',Afhin'200 feet.)--" Septic Tank: Distance from nearest well.. ------Distance from foun afion_--_Ip.........Material........ .. .................. ............... 4, No. of compartments- --•--------------Size.�,XI19---X_ __---Liquid depth-_---- ---------- ---Capacity._..�`d W r- O Dispose field: Distance from nearest well. ---._.Distance from foundafon....___ �-..._--.Distance to nearest lot li o_._�.....__ � Number of lines___------_ �' -----_----- - Length of each line.--- - ----- Width of trench--------- ---------------------- Type of filter material.. .- Depth of filter matenal�'•_.--,/$------_-_Total length..--_-...L_4?.... ... .......... 5 Seepage Pit: Distance to nearest well----._---------------Distance from foundation---------------------Distance to nearest lot line.--.'"...-.._ C ❑ Number of pits---- =_--:::_Lining material- -----•--------•---.Size: Diameter-----------_--- Depth--------------------------------- Cesspool: Distance from nearest well__-__-.--.---.-Distance from foundation-------------------.Lining mater'ral----------------------- ----------- ❑ Size: Diameter. ---------------Depth----------------------------•------------ - - -•---•-Liquid Capacity------••-------•-•---�=--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line-------------------•----------------------------------••--- Remodeling and/or repairing (describe):------, .... , (i- yL_--• -.,� a --------------------••--------------- •-- --- - -------- ---------- - ------ -- I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, St a laws, and rules a d 'regulations of the San Joaquin acaI Health District. �. .®--, [Signed_... = . .. ?rL-C- Z . r Contractor) _ ----••-- r7, e -�c� - {Title_)....-- ---•--------------- - ._ - — Plot plan, showing size of lot, locetion.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -- --------I- ---- - - - --------------------------------------- a •--------------------- DATE..-_F 5- -------r� REVIEWEDBY --------------------•------------------------•------------------------•--------------------•------------------- DATE------ 4 ,,1 -- ---------•------------- UILDING PERMIT ISSUED-------------------------------------------------------------- ------------- ---------------------- DATE------------ - ------------------------------•- ' � Alterations and/or recommendations:-- ---------------------- - :. r' •-------------•----•------•-••-----------•-•----- -•-------------------------•-----•-•----------•----...-----•------+ -------••-------------------•--------------------------•----------- ------------------------•----------------------------------------------------- ------------------------------------------------ ------------- FINAL 'I'NSPECTION-BYi '. .- ."_ - Date- -=. `---- L.,. -•--•- 4 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American•5frte1 � ` < t 30O West Oak Srreetrw. ��.,1'24 Sycamore street)' j 205 West 9th Street Stockton,California i Lodi,California Manteca,California Tracy,California z EB 9 nEVlSEO 0•59 2M 5-61 ATLAS X e