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FOR OFFICE USE: 43Ua "l ---------- 2,2_4JG[----------- APPLICATION FOR SANITATION PERMIT Permit No: .L_-_. .....`�. .... ------------------------------------------------ -------- (Complete in Duplicate) `This Permit Expires 9 Year From Date Issued Date Issued A=C-9.. ........... Application 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 in compliance with County Ordinance No, 549. JOB`ADDRESS AND LOCATION -------Z433-:�i, �* ila-I'l Owner's Name-------- --k------------ ^_ � t ------------------------ ----------- -------------------- Phone................... --------------- Address _. _ -------� /.--`-"------------� YI -----••-•----•---•------- Contractor's Name „� 1::z-F.__ 5�-•�"%Zj�_ ------ Apartment � t ��_.r-------•-------------------- Phon .-----� �� I Installation will serve: Residence A Fartm ouse Commercial Trailer Court Motel Other El Number of living units: 1-. Number of bedrooms _Number of baths __/___ Lot size .___ _-__..-r ------------ Water.Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4Tft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 1 Previous Application Made: llf yes,date-.------------------) No ❑ New Construction: Yes ❑ No)d FHA/VA: Yes ❑ No ❑ TYPE' OF INSTALLATION AND SPECIFICATIONS: r I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance-,from foundation---_-------_-------Material-------------------------------------.____-_____- 0�osaj,'��ielq: ic Trk!"" �4„ %" No. of co•.mpartments--------------------------Size-------------------------------_.Li u . de th--------------------------Ca acit Y---------------- sp _Distance from nearest llk4 � Ditfrom fdo __�_ __Distance f - to nearest lot line___ r Number of lines-----,._.. Lengthfof each ___________Width of french---_4*._ 41-° ________.'-- Type of filter material_ a �l4!-f_ Depth. l____ of filter material___.�_��------Totaf length _ __ ___________________ _ Seepage Pit; Distance'to nearest well-1-Ut-i_4'______Distance from foundation___./_S._.___.Distance to nearest lot line____-__VAT Number of pits----I--------------_Lining material, _ .!_� ____---.Size: Diameter__ ______-Depth______ZZ.�_-_______- W Cesspool: Distance from nearest welt________________'Distance from foundation ---- Lining material--------------------------------------- El Size: Diameter--------------------------------------Depth.'_- -----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from-nearest building____-_____.___________________-______-.-_. ❑ Distance to nearest lot line--------------------------.: Remodeling and/or repairing (describe)_---------------------------.._...-f r____________ ---------------•-----------------------------------•------------••----------------•--------- ------------------------------------------------------ •----- -------------------------------•------------------------------, r ' ' -----------------------------------------------------------------------------------------------=------------------------------------------------------•----------------•---------------- ••-----•-•----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, e I and rules d egulations of the San J Local Health District. [Signed}. ----- ±��------ / t � � ------------------- {l:�r�fe�Contractor) ! BY: ----------------------�----------. -- (Title)--------------------------------------- ---- (Plot plan, showing size of lot, location of system in�elation wells, buildings, a c., can be placed on reverse side). ter ; : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ...................................... DATE....._..._/ .. . REVIEWEDBY---------------------------------------------- -------- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--••--•----- ... -— ------------------------------------- DATE------------ -------------------- Alterations and/or re mmen ation :_--__.-__.__--.-_`:____ _ ---- .------ ---------------- •--------------- ---- --- ----------------------- ----- ---- -------------------------.-----•------•------------ •-•-•---------------- FINAL INSPECTION BY:., ---------------- Date--------1--- -- f � ------------------------- SAN - ------ --- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205'West 9th Street �= c:: w Stockton,California Lodi,California Manteca,Californla Tracy,California C6.9 RCVIBEa B-59 F.P.Ca.2M 5•60 7�, • •.tel