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{ F R OFFICE USE: x ' 1 APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ------------------------ a ------ (Complete in Duplicate) Date Issued -------------- ---------_-------------.---.___..___.-..__ This Permit Expires 1 Year From Date Issued # Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. I &zA-- --------C This application is made in compliance with County Ordinance No. 549. � e JOB ADDRES D LOCATION__ .__�C -- -- - ---- Owner's Name--- i Q one. ----------------- Address------�----'-t-v-_(-_A3D_ g-0_<' ' ---------- .Ur.'— --------------------•-- ....... ------------�l - pp ,� j t 1 Contractor's Name /�__�I�7_Apartqmenitouse �]h'- - l�.T---.. - Q --- - - _._. Pham --- --- Commercial �i railer Court ❑ Motel ❑ Other ��.-- �" Installation will serve: Residence ❑ ❑ Number of living units: :�__ Number of bedrooms Number of baths ___-____ Lot size _--)C_.-- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table �/241ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 0 Previous Application Made. (If yes,date-------_____--------) No F1New Construction: Yes ElFH No A/VA: Yes [INo El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Stec Ta Distance from nearest well-________________Distance from foundation--------------------Material-------------------------_-__-_______--___----. " No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-----------------------� r r isposal ,ield: Distance from neayest well.__-__Distance from foundation------/P___ _.Distance to nearest lot line---- _ '� Number of lines---_!___-___ Length of each line __Cl---------------V�idth of trench_.! -SC li � �j Tyof filter material f ----------- pe ! -_Depth of filter material____9__--_ _--_Total length------------------- �. f , a e !t:^ Distance to nearest well._.r_�___-Distance from`foundation---/,-0- ----Distance to nearest lot line--- Number of pits....__I--------------Lining material__11 cam- Size: Diameter--- - ----------Depth__v __-_-___.-_-__-- Ilk- Cesspool: Distance from nearest well---_------------------Distance from foundation----------------____Lining material------------------------- ❑ Size: Diameter------ -•--------- -------------------Depth--------------------- -----------------------------Liquid Capacity-------------------- - gals. Privy: Distance from neatest well-_:_-._._.__------------------------------------Distance from nearest building--------------------------------------- 475, ❑ Distance to nearest lot line---------------------------------------------- -------------------•--------------------------------------------------•----------------------- `) Remodeling and/or repairing (describe) -------------------------=--------------------------------------- ------ - --- ------------- P� ------------------------------------ - ----------- --- -- - ..--- -- ---- - ----------------------------------------------- ----------------------------------- -------------------------------------------------------------------------------------------------------- -------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance, tat laws, and r es and re ulaTIc of the San Joaquin Local Health District. • Si ned -----------_- � .s ....... 'tt" =► g _( w1F,,ar Contractor) By:------------------------------------------------------------------ ----- -.- ------------------�4j�`! (Title)---------- -------------- ---------------------------- (Plot plan. showing size of lot, location of system In relation to well , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------z�- --------- `9 - ----------------------------------- DATE------ -J - lr" r---------------- _.. DATE---------------------------- REVIEWED BY--------------------------------------- - ------------- - --------------- --• ----------------------- ---------------------------- BUILDING PERMIT ISSUED---------------------------------- DATE j j`- _--� Alterations and/or recommendations:--------��-�-�----��C---��'�_._��-�_ _.---�- -•----- --------='�-•---••------------------------------ __y_ ---- ---------------- -`_J `-= f . - -------------•------------------------------------------•------------- ----------------------------------------------•-- -----------------------------------------------------•- ------------------------ --------------------•-------- ------------------------------------------------------- --------- ------------------ --- ----------------•-- - ----------`-- --- ------------- -- -- ----- ------- INSPECTION BY ..... /_ -------------------------- /AN ----- ---- ------- ------------- FINALDate AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. / 00 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.