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hOR OFFICE USE: ---------------------- ---------------------- --- - --------- __._ APPLICATION FOR SANITATION` PERMIT Permit -------- --------------------------- ------- -------- (Complete in Duplicate) ' -------------- ----------- --------- ------ -------- This Permit Expires I Year From Date Issued Date Issued l�_.:/ig� 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. jpw.J06 AD� � j , _ DRESS-AND LOCATION------ A[�e ZY'd T. - �•--------------------- Owner's Name------C,.�.d•�.,�i._�--�•--�..,,.�i,C�_1_L��_- � `- Address-------------- .�. �-_ 1 tv r1-4-aa------------ - �_ -•--- Contractor's Mame_,- t --••-•--•- `- •--•-•------- ' � ''' 5 1A Phone�__ i I kO Installation will serve: Residence ( Apartment House- e+-C - ' ', .� '4 a ^-� ❑�omercial.,❑ � raifer Court ❑ Motel ❑.�Other Number of living units: ---t--- Number of bedrooms ---- of baths ___- Lot size Water Supply: Publiclsystem ❑ Communit system , `, 6 Y Y �.+�Priy�te �D�pth�toWater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑4` Sandy Loam CIj' Loam Clay ��,,�►► Y' ] y ❑ Adobe ❑ Ha` dpan ❑ Previous Application Mader (If yes,date---------- ------ J r 1 No ❑ New Construction. Y'e`s t` No ❑ FHA/VA: Yes ❑ No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: "(No septic tank'or cIss`poolpe'rrnitted'if public s�wer=is available within 200 e . } —. - .,nom– A. i Septic Tank: Distance from nearest well:----- -_Distan ce from foundation_- 4 .P-_ Material_" .0 -$_ _ 7�3t . x No of tom artments_..__..._ _- __ t e? i p Size- ` ----Capacity- -- -' '7 ` + depth Disposal Field: Di st ante from nearest wel!___s'd._Distance from f unddaf�ion g/° �_"sg � r �� Distance to nearest lot line_____ -- .147 Number of lines._ -t _- Len th of ea h IEn _ A g -- - Width of trench--- - ---- _ e of filer material-- ---_ - __De th,of;,fil -----•-- Ty!? �w. p Jr rTerialr (�+ Total len rth'?_. Seepage Pit: Distance, to nearest well_____ ___ _________Distance fram foundation' "� " '"'"nc,-fo Sre, e ____.Distance to nearest lot iine_____. py_ ❑ Number of pits----------------------Lining material----------_---------#,Size: 4Diamefer,.------------------_ -Depth---- --- - Cesspool: Di}tang from nearest well_________________ ,r i � ; Distance fromxfounrJa tion. rLining�matenal__�.- :-,R------ ----- ---- SA: Diameter--------- D •w-k --. Priv Di[ - p w ;Li u,i apacity�+" gats. Siz --Depth stance from nearest weft w4...... .,.. ..� .�.._ .e��._..� ,� -----------------Distance from nearest building ',`f Distance to nearest lot lire______"___. - ---------------------------- -- Remodeling and/or repairing (describe):- .--� -------_ -- - - -------- ' G �a ----------- ------------------------------•-----------------------------------------------------------------------------------•------4------------- ------------ ----- ------------------------------- ---------------------------------------------- ------------- -------------------------------------------- -'---------:-------- -------------------------------------------------------- -----.-- ------------------ ----------- - ------------ I 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 a regulations�of the San Joaquin Local Health District. • . (Signed) " w wne or Contractor) �. (Plot plan, showing si a of lot, to ion o sys m.m rel tion to wells, buildings, etc., can be placed on reside}. OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ll� -7�r,------------------------------------- -- DATE----- = esF_=�. REVIEWED BY .._.- DATE - - BUILDING PERMIT ISSUED--------------------------------- ------------_ Alterations and/or recommendations:---- - -- -----��' — DATE p----------------- - -------------•----------------------------- ---- ------ --i-------------- --------- --- ------ ------------------- - ---- ---------------- ---------------- - --------------------------------- --- 7 FINAL fNSPECTIary-Bx: J ---------- -- ---------� ----'1 Date------ --- ..w-------------- ............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.