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FOR OFFICE USE: .4 �---------------------P-------- r APPLICAT40N_ FOR SANITATION PERMIT Permit No. ----------------- ------e - ------------------------------ (Complete in Duplicate) ----------------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued 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. - r ! JOB ADDRESS AND IS � . d6� ' ( ? --------------------------------- - Phone---------------------- Owner's Name- ------ A ---- Ader = -= k -- - -------- - �' r Y'� s � IV Contractor's. Name%'- t y r -------------------------- ------------ Phone----••-•------------_-•-- . _ � �'-----=-- --- Il serve: )%s'sdence ®' Apartment House ❑]Commercial -ail�Courrtt�❑ Motel ❑ Other / 1 InstallatNumb.,V It �� ms`s, �� x � / Number of living units:..-' �--- Number of bedrooms umber of b hs _1_.._ Lot size ___-rp__p X---�______________________ _______________ s Water Sup y: ,>Public system ��inmunity system ❑ Private ❑ Depth to Water Table _ ft. I Character of 'soil to a epi of 3 feet: Sand ❑ ,Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[0'-Hardpan ❑ Previous Application Made: '[If yes,date-------- --_.5. _._I No [" New Construction: Yes ❑ No FHA/VA: Yes ❑ No �t s r� TYPE OF INSTALLATION AN6 SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) . �^ Septi ank: Distance from: nearesr well_--___,______Distance from foundation_____________.__--.Material------------------------- _65��, A�_ of tom artments_________________ ___f Size__________._________________.___Li uid de th__________._...._.______._Ca acit8tr p - - -- q� � p. p y---- ------------- No. Dispos i Distance from: nears well-da----__.__Distance from foundation____..____-Distance to nearest lot line___..________ r . ,f Number of lin;es__.. ___________________ Length of each line----- .Width of trench___'^z_ .,_�y_.____...________ Type ,� Distance o filter material--- length__4>7> 1_f______________________ k T e of fitter material__ .____ _:-___De Depth of fiat I 09 Seepage:Pit: , Distance to nearest well_./��_.________ m foundafa,on---/Qd---------Distance to nearest I t lines __ _____ . !\lumber of pitS._r`�__ Lining material. La� __Siz'c: Diameter ----`' ------------Dept � -------------- O I . ,,. -. 1 _ —... - Cesspool:., Distance from nearest well_________________Distance from foundation----------------- material______.-.._.___._-___________._-____. ❑ Size: Diameter------I-------------------------�==- -Depth----------------------------=--=='----Y------------Liquid Capacity----------------------------gals. f nce Privy: I� Distance`from =. nearest well - =------------------- Dista --' from nearest building ' ❑ Distance fo nearest lot line----------- ----`--- -------------------------- Remodeling and/or repairing (describe):--------- _ ---------------------------------------------------------------------------------------------------------- ------ ----- -_ i ---- l . Vic: t. , ------------ -----:----------------- --------------•---------------- - --- -------------------------- --- I hereb certif that I have re ared this application and that the work will be----.----- ' y' y . p pp done in accordance with San Joaquin County ordinances, State laws, and rules .and regulations of the San Joaquin.-Local Health District. (Signed) ; ----------------- ---------------- ------------------(Owner and/or Contractor) Ey:------------------ -t=--- ---------- ---------------=--------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of syst in relation.toyweIts, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY------ ------- G„" -------------------------------------- DATE------ ~' ----------------------- REVIEWED BY: --------------- '-- - ------ ----------------- ---------- DATE AlteraIions PERMIT ISSUED-------------------- -- _ ----------._----------- !----- DATE------------------ -------------------------- ----------- 1 U ;d or recommendations:.-----•�---1-'- - ' � S '�`✓t-��--�_--•-�6-`�'�`------`-._C_�—G_:�'�.r--- ,¢_ter-7" [_c _ �✓ — CLQ" = t -' f _' -- ---��---- 4 �` __ t' ----- t I c el t ---------�,----------------- � -� - ---------- - ----- '-'------'-'-.. ------ mac_-` -------- r L i --------------- M1 I' �� ------------ � FINAL INSPECTION BY:--- � Date------------ � ------------------------- ----------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Haxelton Ave. 300 West Oak Street: 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California. Tracy,California ;� F.RCO. ��. 1