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l APPLICATION FOR SANITATION PERMIT` Permit No ..IH!! J . . _ - - v �,� . -- --------- (Complete in Duplicate) This Permit Ex fres I Year From Date Issued This application n "" Date Issued ,:�-'� .. — Application is:hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. is made Tri compliance with County Ordinance No. 549. i; JOB ADDRESS AND LOCATI N.... Owner s Name. 'moi --------- -- --- - - ------ Address--., ----Address y� ----------------- --------- Phone` -•--- Contractor's Name......_ Installation will serve: -Apartment -- 3 Phone .......•---- Ge Apartment House Commercial . I '� ❑ ❑ Trailer Court ❑ .Motel ❑ Other ❑ Number of living units::":f Number of bedrooms _ x• '_ Number of baths _/. Lot size _ �< Water Supply: Public system,[] --��---��.----•-•-=-----••- -• -_ Community system ❑ Private [Depth to Water Table t `Q.ff Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam [] Clay Loam ❑ Clay [] Adobe 2�-Aardpan ❑ Previous Application Made: (if yes,date--------------------) No New Construction: Yes No, TYPE OF INSTALLATEON AND SPECIFICATIONS: ❑ ©�FHA/VA: Yes L3 No �-- (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) � { I Septic T nk: r ; from nearest well_________________Distance from foundationMaterial _ lEft/a � No of Distance --- ------- ---Size--------•- Liquid depth---•----•--------------•• i Capacity Disposal Field. Distance from nearest well_"_,A_""" } "'"'". ......•• Distance from foundation___./:Q--"-----Distance to nearest lot ;,y;TNype --.__--l-i_n e- 7-umber of lines--------- --- - "A__ Len #h of each line-___ ?�:- -----"--"--._.Width of"tnch._oZ ' ,� -- __ Of filt'e'r material .._.. _ pofilter -------- iength_��Qe SeepagePit: Distance to:nearest ---•.•_ well "��Q_�_"_Distance fryyn foundation_ _. Number of pits___"-,�"_ ��-------Distance to nearest lot line__._'_- v _.______Lining material._ _ _"_4---Size: Diamefe �` f Cesspool: '�3-------- ------Depth__.�,a`_.-_....._.•_.----- � ❑P Distance from nearest weal--------------___Distance from foundation--------------------Lining material--------.__._•___ IS;ze: Diameter---------------- ---------------------Depth-------- - •-----...._.......-- --•---------------------Liquid Capacity Privy: f Distance from nearest well--------------------""-- � q p �--•---•---•----•--•---.._.•.gals. _ ---------------------_._Distance from nearest building___.____•--------"---__ nearest lot line----------------- ' ----------------- •---------------- - r Remodeling and or re airin d Is ante to ----=--- --- � ` -----•------- "--•--•--•----- I - •----•--------"------- -------------------------------------------=••-------. ` - 1 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)------------- =' " r -----( r Contractor - --- ..r . rifle)_•---•- 1 (Plot plan, showing`siie of lot, location of s m in relation to wells, buildings, etc., can(rifle) placed on revers), f. . s ------ (Plot - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED fBY-'- .�!_.�i " f . REVIEWED DATE_.--- - ------ ------------ --------- / syr ------------------- ----------- BUILDING PERMIT ISSUED__.------- DATE.------- -- ----•--------•------••-•------- ------------------------------••-------•-•------•---------•----- A orations andfor recom nda+ions:.--s ---- DATE_-•-----------------------•--------------------------------•- ........ ------ ------ ------•--------• --------------------------------- -r-------•---------•- ------------------------------------------•---------- FiNAL INSPECTION BY:.__�,a Lt.S -----" Date.....-3�' 2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street € i 300 west Qak Street I, 134 Sycamore Street Stockton,CaliforniaLodi,California' ! f 205 wast 9th sheet ES 9 REVISED B•59 $M 6-6r ATLAS fAanteea,California Tracy,California