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VUR OFFICE USE: —� ------------------- -------"- ----- - -.---------- APPLICATION FOR SANITATION PERMIT Permit No. . __.�,,._ ------ -- _ -- Z-zrz 4.f!! "" [Complete in Duplicate) From Date Issued ,�� Date Issued •__G16— Application is hereby made to-A's San Joaquin Local Healfh District for a permit to construct and install the work herein scribed. This application is made in compliance with Co my Ordinanc No. 549. �b ~�, Pp_ OB ADDRESS AND CATION Owner's N e---- � - -- f Address---- --•-------- one N%fftfU'f'E� Contractor's Name___ _._-__ ---------A-;---- _n _ ----- ---•-- Phone---� _ ?`� Installation will serve: Residence Apartment House C artist ❑ Trailer Court t ' tit ❑ Motel ❑t Of ❑ a Number of living units: ---/- Number of bedroom .'-_- Number of baths I Lot�e ____ ` Water Supply: Publics stem ; Y ❑ Community system ❑ Privatet Depth to ater!Table .y?.ft. Character of soil to a depth of 3 feet: Sand C 14-ravel ❑ Sand Loam a LoaClam YC 1f ❑ y ❑ dobe❑ Hardpan ❑ Previous Application Made:r{lfyes;"date".`.""__----------) No 9?--New Construction: Yes,0� No FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cess ool- ermiffed-if'public-sewer is available within 20b-fee itst] f P P v fan Distance from nearest . ��Dista�ce"from foundafion ---__ aterial-__ __--�-" --- No. of coV4 mpartments_ Size '"R -T --------------- --- ----------- -� '-- - did de"fih I--- - D asst r .t+wiq p Capacity W Distance from nearest welL_+p t -. , 0 4 V Distance from foundation__"___ - (stance to nearest lot line__--_/ Number d lines-__ _ - - --------- Length of each line_ r �� , T e of filter �� V✓Idth of trench_ . -__-----" or --� YP i_ Taterial. � >� _ _ _Depth,..of�filter�_ aterial------�� otal length-------•------- Seepage .�� - ` �f Pit: Distance toArarest well-_-__-_ _. ____g"---Distance from foundation____-_.---" _--_- 1' ❑ Number of its----------------------Linin material-----_-----_ Distance to nearest lot line-----------_----- Size: Diamefier ---- f DepM--------------------------------- Cesspool: Distance from nearest well-----------------bistance from foundation.- _.__...L;tying material___.__------- ❑ Size: Diameter--------------------------------------Depth- ---- 1 0.rid Capac,tY--------------- Priv gals. I ❑ Distance to nearest lot Vine.___ Distance from nearest building Y� Distance from nearest well____...._ V. Remodeling and/or repairing (describe):------ - --------- -------• ;V d-------- - --- -------------------------- --------- ----------------•--------- _- � . -- pA, ------- -----------------------I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count Y y P R ordinances, State laws, and rules and regulations of the an Joaqui ocal Health l)istric#, q y (SignedAe-le1 By:--------------------•-------------------•--------•---------•- - _Contractor) ----- ---- -----------(Title)_ --- -------- ----------- 7 (Plot( plan, 9 -- --- ------ - ------- lan, showin size of lot, locationjof system in relay to wells, buildings, etc.,.can be placed on.reverse side). FOR DEPARTMENT USE ONLY Aj tow APPLICATION ACCEPTED BY. -.--f j- '-a REVIEWED BY --------- -------------------------------------- DATE_ ,�=•- " -------------------------- --- ---------------------- DATE_- ------------ UiLDING3RERMITr155UED,----__ -� --- ---------- ---- ------------- -- ---- - DATE_---�- ---------=----- Alterations and%or re-' c`�` 'dations _______ ___= =- �� --------------- " IIA ----- - -------------- -•--- - ------ -------- -- -,.v i ----------------------------- ------------------- -------- - ----- --- ----- 1 FINAL INSPECTI BY, 'l'�'�- ---- --- - -- -- - - Date._.. -------- �.---�- -----r--- ---- -------- �----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West th Street Manteca, California Tracy,Callifornia ES 9 REVISEo a-s9 3M 3-63 F.P.Ca,