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APPLICATION FOR SANITATION PERMIT Permit No. ---- -- --0--------- (Complete in Duplicate) 9 Ik .1 Date Issued --- VVV pplicavIi,ri is hereby made to the Son Joaquin Local Health District for a permit to construct and install the wok herein described. This application is made in compliance with County Ordinance No. 549. o JOB ADDRESS � D LOCATION------*A..0 - ---------- -------- - ---------�/Ln_e------ ------_-----------Z-f-kpi,_ OwnerI e.... Phone---454!f s Nam _ __ ------ ---------------------------------------------------------------------------------------- 'Af Address-----------------------4 ........ -------------------- -------------------- ------�a 6 ---------------------- ----------------------------------- -------T__rL -------------------------------------------- P1 0 6�?,�Q '7 6---------------------------- Contractor's Name-- ---- # Installation will serve: Re"sje—,7e Apartmen+'H&Gse E]--Commercial E]—T-railer—Court-,D—ma;l"[,—, ] Other ❑ Number of living units- --A--- N ber of bedrooms __Z__ Number of baths ----/-. Lot size -------/9P�___------- i Water Supply: Public system ;�<:unity system 0 Priv.ate E] Depth fo_'Wafer"Table _4_©ft. Character of soil to a depth of 3 feet:" Sand.E] Gravel E]I Sandy Loa m E] Clay-Loam E] Clay El Adobe Hardpan El ttt N Previous Application Made: Yes vy ��J�rri E] New Construction: Yes [:I. No E1.4 f 4� 6v% 6 TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or!cesspool peri6ifted 'if public sewer is available within 200 feet.)ti e c T&ikk,:" Distance fromnearestwell-----------------Distance from foundation--------_----------Material------------------------------------------------ No. of compartmien-Is...... ------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- ?;j�2po sp I FlPgS;. Distance from nearest well------------------Distance from foundation--------------------Distance to nearest iot line_________________ Number ine----------------- Number of lines-------- --------------------Length of each line-------------- ----------Vidth of trench----------------------------------- Type!of fifter,lmelaterial------------------:_, Depth of filter material-----------------------Total length----------------------------------------- Seepage ength------------------------------------------ Seepage ;t: Distance to nearest well;b..099-------Dista c from foundation___Distance to nearest lot line____ Size: Diameter--- - ----- Nu4er of pits, j-- --------------Lining 'Material- ........I --- _31 -_Depth---Z_Z Disfahce from nearest well-------I--------=Distance fr m foundation--------------------Lining material______________----------- IC, ,_Cesspool: 4- 0 ---------------gals. Size: Diameter------ -------------------- --------------------- ----------------------Liquid Capacity-------------- Privy: Dista n1c_e_f1r�omnearest ------------ ------------------------------------Distance fr7_n`e`,*_r_est b_,ilc�_ng_�---------------------------------------- El Distance to nearest lot line__-_-_---.'-_____-____ i---------------------- Remodeling and/of repairing (describe):------------------------------------------------------------------------------------------------------------------ •---------=--------------------•- -------------------------------------------- ------I-------------------------- ---------------------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------I--------- ------------------------------------------------------------------------................. ........-------- ------------------------------------------------------------ ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------- I hereby ert y I Prepared application and that the work will be done in accordance with San Joaquin County sl�a ave e ordinances, S to aw L,1'e a laf' o and S and reg ns of fhen Joaquin Local Health District. (S.igne'd)--------- - ---0 _164-5«------ 17-C-1-—---------------------------------------------------M Contractor) By:----------------------------------------------------------------------- --------------(Title)- --------------------------- .a wells, .(Plot plan, showing size o relation to ace f lot, location of system etc., can be aced on reverse side). V FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --A --- - - - --------------------- ......... .....I----------- DATE------------------- -- ---------------------------- REVIEWED BY--------------------------------------------- - ------------------------------------------ DATE-----------------�_q-------------------•. ----------- BUILDING PERMIT ISSUED---------------------- ------------------------------------------- DATE--------1-/--------•--•---------------------------------- Alterations and/or recommendations:------- --- - ------------------------------ ............................_71�-------- ---------------------------------------- ------------- -------------C;2.N --------------------------- --------------------------------------------- --------------------------------------------- -------------I---IA------------------------------- -- -----------_--v------------------------------------------------------------- --------Coz-, - --- ---------------------------------------------------------------- -------------- --------------------- ------------- - ------ - -------------•- ---------- - ------- ----------------------------------------------------Z------ FINAL INSPECTION BY:----------------- "L4 ---------------- Date------------------ AN JOAQUIN -- ----------------- ---------------------------------------- LOCAL HEALTH DISTRICT 130 South American Stroof 300 West Oak Street 132 Sycamore Sfre!4 814 North "C" Street Stockton, California Lod;, California Manteca, California Tracy, California FS-9-2M Revised W-2100