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rvrcvrrlC.0 USt- x sus - - APPLICATION FOR SANITATION PERMIT Permit No. - .2.1 _v ------------------ - -------------- -- ----- (Complefe•in Duplicate) -------- -- --- ------ -------- ------ ------------ --- This Permit Expires 1 Year From Date Issued _7 Date Issued _/_.1_-��1 Application is hereby made to the San Joaquin Local Health District for a permit to construdt and in II the work herein descried/. This application is made in compliance with County Ordinance No. 5 9. JAI �vece�y JOB ADDRESS AND LOCATION.__-_k�2/7 '- �/ l Owner's Name. W.'+-"?7 lQ�' / ----•--- Address - -------------- -------. Phone� (--'� /� �L-�C,�-.mmercial ^� Contractor's Name`s �.�_ __� . � / Phone-oz-------------- ..-----•--••--�-------•----••----------• Installation will serve; Residence Apartment House. l Trail � � ❑ Trailer Court ❑ Motel ❑ Other ❑Number of living units: __ Number of bedrooms Number of baths_ __.__ Lot size _ /_ • r Wafer Supply: Publics stem ' /� _}J `- l-- Y. ❑ Community system ❑ Privat Depth to Water Table ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay t I I Y ❑ y ❑ Adobg Hardpan ❑ ' Previous Application Made: Of yes date___-------- ----_.- ) No ❑ New Construction: Yes ElNo� FHA/VA:,Yes [INo E]TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permifted if public sewer is available within 200 feet.) t, a Se is '""Distance from nearest well __ -----Distance from foundation------------------- Material ----------------T,--'- No.Lof compartments_. ------------------Size----- -------------- -- -•---Li uid de th---- D' osa�,e 9 P -- ------ ......- Capa,city--•-------------------. Distance from nearest well/dQ--_--Distance from foundation__ .__ -- Number of lines.__ -____ . ��--- Distance to nearest lot line__ _- ----Length of each lin .0s �- Type of filter mate ' � Width of tren h_cL -- ------ Depth of filter material___ y f' ��. .- Tofial lengt a e it- Distance to nearest w �� ------------`---- ��_.--Distance rom foundation_- \y Number of plts__�_.__ _- ----.Dis ante to nearest lot line__...------ V Ix! ---._.__ Lining material____________ _ a Size: Dia meter.--.-. Depth--- Cespf�ol: Distance from nearest well ______________ Distance from foundation----------------- - Lining material-----------------------_-------- ❑ " Size: Diameter- -- `--- --- - -- ---- --- --- Depth----- -- -----�- ----- - r ...... - -------- -----Liquid Capacity_._. gals. Privy: } - Distance from nearest well------------------------------------ -°• Distance from nearest buildin ❑ Distance to nearest lot line.-------_---------------- g------� ------- ------- -------- -.-. ------------------------- Remodeling and/or repairing (describe):__. -- --------- -------------------- ---_ -- /i� -------------------------- --- , 1- %ti. - - - - - " - f = }: - - _ - _ 4 :� _ _________ ________________________________________ I n es, S cerci at I have prepared•fFiis a lication and that the work will be done in accordance with San Joaquin County ordinances, St a law d rules d're. ulafi s of an J n L cal Health Icf. . . ---- fl�' t BY:----------------•---- ----------- -- � Title Contractor) .,.C orJ (Plot plan, showing size of lot,"locafion of'sys+em}n relation f ells, buildings, eft., can be placed on reverse side). -------( J----------------- --- - --.. -- ----- --..--- --..: fi FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- __._. - e.- ------- --- DATE-- - �------ ---------- ` �. REVIEWED BY------- 1 - ---- -- - - - DATEBUILDING ----- -------------•---------- Alterat ons and/or recommD ndations: I --- ;. ----------- - --- ---------- -------------- - --- -._ DATE----------- --------- ------ ------•-- -- ------------------------------ -- ----------------------------------- ------------------------------- ----------•----------------------- ------ . y ____________________________________ _ _____________________________.__.__._-. y____.....___ ----------------------------- .. FINAL INSPECTION BY:__----------- - - i _. - Date_------ -��-��-�--~��-�- ---- -- --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxollon Ave. 300 West Oak Street �N 124 Sycamore S#reet Stockton,California Lodi. California 205 West 9th Street E.N.9 2M 1-67 Vanguard Press Manteca,California Tracy,California /`'/"/