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FOR OFFk Permit No. ---------------------- - -------------- APPLICATION FOR SANITATION PERMIT - --- -------- --- --- (Complete in Duplicate) Date Issued ................. ---------7- -- This Permit Expires 1 Year From Date Issued the Sain Joaquin Local Health District for a permit to construct and install the work herein described. Application is here y made o f This application is made in-compliance with County Ordinance No. 549. I , k /Cff�_v---------------------------------------------------------------------------------------------------- 7 JOB ADDRESS AND i LOCATION-- As Phone -------- --------- -- _V----- Owner's Name-------- A)1) AQ �"�7w ----------------------------------------.-------•--•----•--------------------•------ a yam. -- --------- ------------------------------- ------ Address-....I-------------- -------- do Phone----------------------------------- t ---------------- ------------------------------------------- Contractor's Name---------------------cawwk�_ ------------------------------ r. Apartment House E] Commercial ❑ Trailer Court E]. Motel Other Residence [I Installation will serve- Ell Number of living units: _/--- Number.of bedrooms Number of baths I---- Lot size ------------------------------ , Water Supply: Public system 91 Community system Private [] Depth to Water Table ft . .4 Clay Adobe Hardpanc] Character of soil to a depth of 3 feet- Sand E] Gravel El Sandy Loam..El Clay Loam El No Bel Previous Application Made. [if yes,Ilate-------------------- 0 New Construction:Construction: '?es [;a- No E] FHA/VA: Yes E] TYPE OF INSTALLATION AND SPECIFICATIONS: available. within 200 feet.) &,O&ez,6� ce, --(No septic tank or cesspool p6rmii-ted'if public sewer is 01 le"Ieidvoo IF from foun Ion------/P--------Material Material_____• _________""Tank: Distance from nearest well.,40------Distance ---Liquid depth-------4----------- -t aci No. of compartments----a),------------_size-----ld_� I C/ from fo�ndafion_.___/1).........Distance to nearest lot line-------------- Distance from nearest well,-J-4)---:.-Distance _h Dis I Field. ---------------------- 1;;�th of Number of lines- ------- --------- -- each line--- of b----------------width of trench--- ----- •7 T'pe of filter me.te-r-i-a --Depth of filter material------ -------Total length-----4F0------------------------------- Y ., Fg. rest lot line------------- Gl Seepage Pit: Distance to nearest well_-- ----------- -----i Distance from fo.undatio.n-Diameter----•-------------- Distance to nea ------------ Number of pits---------I--------------Uning material---------- -------'-----Size -----Depth--------------------- El .. I t e from foundation ___.Lining material___._________._-------------------- -Distanc ---------------- cesspool: Distance from nearest well_____________-_ A I IDe --------------Liquid Capacity--------------------------ga els. Diameter."-_"---------------------------------- pth---------------------------------------- ❑ ---------- Privy:!4�'- Distance from nearest well--------------------- ----------------------------Distance from nearest building------.---------------------------- I_ I-- — ---------- Distance to nearest- ----------------- --------------------------I----- - f --- -------------------------------_------__---------------------- Remodeling and/or repairing (clesc'ribe);------------------------------------------------------------------------------- I-------------------- -----------------------------------------------------------I-----------I----------------- ---------------------------------------------------------------------------------------------------------- 1!T I F R. 7% ---------------------1-_.._._______----------------------------------------- ----------------------- ------------------------- --------------------------------------- -------------------------------- 1. 4t. . . --------------------------- ---------------------------------------------------------------------- ------------------------------------ ---- ---------------------------------------_:------------------ ----------------- I hereby'ceirfify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State laws,,and ra�es {and .regulations of the-San Joaquin Local Health District. ( - --- -------------- - er d/or Contractor) SiSignedt - -- - ...........----------------------- ----------- -- ----------- ---------------------------- -- ---- -------------------- -- ----------------------(Title)-------------------------------- ------- --- - ------- (Plot plan, showing.size be placed on reverse side).of lot, location of system in relation to wells, buildings, etc., can, - FOR DEPARTMENT USE ONLY -------------------------f- ------------------------------- APPLICATION ACCEPTED BY------- — - ------- ---------------------------------------- DATE W DATE.......... --------------I--------------------- _4��_ -------I----------------------------------- ------------------------- --- - ---------------------- REVIEWED -----------------------:---=--- - TE �i ------- DATE PERMIT.ISSU. ED---------i----- --------------------------------------•- Alterations --------------------Alterations and/ocrec6mmendlio ---------------------- ------------- --- ------- ---------- ---- ---------------------- . ....... .. ------------ ------------------------------- P-- - ----------- ---- ------ -.------------------------ - ----- -------- ....... . .. n-------------------------- ----------------------- ......---- ----------- - 13 - - t I 7—4'7 . 1. Date__.----- ------------------------------------- FAl - -- - - - - --------------------------- iNAL INSPECTION ......_ A �0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 west Oak Street 124 Sycamore Street 205 west 9th street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 AEVIe�o 8'54�-P-co-2 6-60 -