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APPLICATION FOR SANITATION PERMIT Permit No, _ 1 T (Complete in Duplicate) y� / ISL Date Issued _______' 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 ompliance with County Ordinance No. 9. JOB ADDRESS AND OC ION ___ ------------------- _ Owner's Name---------VZ4` + ---- ----- Phone . Address---------� =--- y��Aparfmenf � --- - - ---------- -------------------------------- h n ----- LL Contractor s Name � ..� a Phone_ _ �,� Y� i /, a Installation will- e: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O ❑ .. w `/ t Number of living unitis:+ __ Nu er of bedro mslW- Number of bath _ Lo#size!__________________2�___ _ __r.___.".____ Water Supply:"'Public#lyst�� ornmunity syssyste m_.0 Private❑—Depth to W9fer able-_ ft. S Character of soil to a deptFS'of-3-feet:;.Sanc1'❑i �Gravei ❑ Sandy Loam ❑ Clay Loam _- Clay ❑ Adabe rdpan ❑ Previous Application Made: :Yes ❑ No ❑ ew'Construction: Yes ❑ No FHA%VA: Yes ❑ No - + 7U,,,OF INSTALLATION AND SPECIFICATIONS: , ' :(No septic`fank:or°celsspool permittecllif publi&'sewer is available within 200 feet. 3 tante from nearesr well______-____-- Distance from foundation_______ _-__41--_-Material____"_-__________-"_________________:_______- nt -------------------- ------------ &0 a _ ,�. �, No of compartmets 'Si Liquid depth-- .----------- o al .eld: Distance from. nearest well------ ---- _- Distance from foundation________________".__Distance to nearest lot line__________-_-____ ! ------- Number'of lines-----�-------�`�----------- -�-Length of each line------------------------P_�Width of trench------------------------__-- F. „I l Is_ ` I Type of filter?mater,,;al------------------------- epth of filter material-----------------_---__T_atal leng#h----------------_--------_----------__---_ I I Sl # � __ _ _=_Distance" "rom-foundation____ �__ a $cepa a Pati Distance t'o nearest well,_"_"__ �p�-..___.Di•ta ce to nearest lot line____ :__"_ $ Number of pit ' "�- ____Lining materiaL_ _ i."__"Size. Diamete`r____ �� Depth__ � 1 , .. Cesspool: Dis'ta'nce_,f om nearest well----- ____Distance fro foundation--- ---- --__ Lining material--"-______."__._:---_.------.________ ' Ati. e-. Diameter---------- - _ r` Dep a } i Liquid Capacity . ' Sals. Privy:❑ Dis ___-1-AllL–L.,i ` I Lance.from nearest well_______--- __77Z-1 _._Distance from nearest buildin ❑ y Distance to nearest lot line_________ ______ ' i _____"_ __-"-___- - -----;f ----- - -------- - Remodeling and/or rel�lairin�g [cle5crib . _ -__ --, 1 _____ R - - r i f�i � � ,i qh - � - - - I { I IIS E I �hereby-certify'tlikat"Pave prepared this applieation'and-that-the work will'be d�;Kn accordance with San Joaquin County ordinances, St wsiandl;rul nd re lations of the S J aquin Lo alth Dict, d p 4 /1� - - ------ ----------------- ----------y-------- � Contratta X1 (Signe } Y= ------------M-••••-i`: :i - {Title} [Plot pan, showing sizeiof hot, location of system [n relati Is uildings, c., can be placed on reverse side}. FOR 15EPARTIVIENT USE ONLY i APPLICATION ACCEPT D BY ------------ --- A- -----------------------•---------- ---- DATE-- -----•----•------------------•--------•- REVI1 WED BY ---------'---a:----- ill --------------- DATE----------------- - _ -t BUILDINGPERMIT ISSUED111--------------------------------J-------------=f----------------------- -----------------�DATE----------------------------------------------------------•- Alterations and/or recommendations-------- ------------------------------------------------------------------------=----------"--------------__------•-•-------------------- ---------"-- `II. ------------------------------T-- - ! 7 — - - ------------ --- ! _6.. ,-!,j __. I FINAL INSP11 CC, ECTION BY, --------- -- _ `- ---. Date4 _ 12 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street;: 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street ` Stockton, California Lodi, California Manteca, California Tracy, California , k ES-9-2M Revisea 1-571 F.P,co. i III I