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.,i rUK urrit-t Ubt: - �^� ---------------- ---- ---. _- :---_..__:- z_-. -- APPLICATION FOIA SANITATION PERMIT Permit No. _ ffdc� 4 I� (Complete in Duplicate) I� -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heal+h District fora ermit to construct and i This application is made in compliance with County Ordinance No. 549. p ; salt the work herein described. JOB ADDRESS AND yL�O�CATIONT , ,f~------------------•-------------------------------- Owner's Name-------/=! E G°Q lit i r' �------- -- Phone---Tn-?z---- 5,3 k r Address----------------- C09tractor's Name-----t �7J"rl ' - ---- ---�z�� /�k�'.�------- ------ _---------- Phone_.--------------------------------- Installation will serve: Residlonce Apartment House Commecial E Thailer„�Court(�,�Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number of bathe"______ `Lot size__ --____________________________________---___-___.__ Wafer Supply: Public system ❑ Comm uriity�sj-ystem ❑ Private Depth oto-Water Ta41e`<_ . ft. # Character of soil to a cle fh of 3 feet: Sand Sand'Nam r k P t 0�' Gravel ❑ Sandy L'rsam ❑ Clay Boat] Clay ❑ Adobe ❑ Hardpan ❑ t Pre Hous Application ade:K (If yes,date_,_.._._...w--____-_1 No ❑ New Construction ❑ o*[] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPEC IFICATI NS: (No septic tank or cesspool permitted tfap,ublic sewer is available w Thin 0 `fee#.) i Septic Tank: Dista<e from nearest well •''-,_____.-__Dis ane from foundation ►' .._____-_- _ _Mate-tal_______ _----_------ ❑ No f 'compartments----__ ILII -- --...Size--- ------ L ,---Liquid de t 11-----------------(r Gapacity---------------r Disposal Field: Di -1A from nearest well � ___Dis an ce from foundation_____- _ ' :Distance to ri.elst lot Ikne_,o_ ?�_-. { Number,; of lines-------------/-- ------_--- Length of each lin ~--- �—Width of trench.--__- - f r I� Type offilter materia .5 _ _ -.Depth of filter materodi_.--._/ ....___._Totai len th''_._._- .` Seepage Pit. Distance to nearer'=well_.____ _�1 `��Dis}an, e- fro foundation_____ �,�,/ . _ _.Distance toinearest lot lin e__ ��_ Numbers of pits._..____f---------Lining material____ ers� _..;Size: Diameter_. 3!!--.___ Dep`fh.... Cesspool: Distance from nearest well_____________._--Distance from foundation.-.__.____--_____..Lining mate ial. ____--.-__-__________._-_- 4 .� 4 I❑ 5iz Diameter------ Depth ---� Liquid Ca a&'k y gals. Priv': Dist-6nce ,rom nearest well -_'k-_____._.__ _ Y "V. � --- - ---.................. stance from nearest building----------------------------------------. ❑ MSTaanee to nearest.lot line\_)N------- - -------------------- �}� --------------------------- Remo elin and/or re a ri descri4/'W. a4 `I ------------- IF ' ' II I ;. y 1 = _ - ,1I herebycerfif that�l 'have prepared this } plicafion and #hat the work will be done in accordance with San Joaquin County ordinances, State laws!ia'nd�irules and regulations of the4,San Joaquin Local Health District. n (Signed). 0C._./Sri_ 1'e7es----------------------------------------------�(Owner and/or Contractor) r (PIofelan, showing size of lot, a#ion of system in relation to.wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ---_-.._�__-.. ^-- DATE------- REVIEWED BY------------------------ - DATE - - ---------•--------------------------------------- BUILDING PERMIT ISSUED------ ------------------------------- - ---------------- -------------DATE- !� a _. l=_`t;. C Alterations and/or recommend -- . - ---i- ---- --- ----- II, ----- -- Ip ------------------ ----------------------- ----------- ----------------- ---- ---- --- ---- - - ------------------ ----- - -------------------------.------------------------------------------------------ -------------------------------------------------------- I� FINAL INSPECTION BY:.. '._(. -c-� ---------- ---------- Date------------------ / _ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT y 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California - II -�