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min VI rl%„C UJC: �- r r 3-3d APPLICATION FOR SANITATION PERMIT Permit No. .rr_11� -------•----- -------------- -- ----- `i- (Completen Duplicate) --- --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins I the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS Ay LOCATION_._.& --- - Owner's Name--- "- - - -- ----------------•-------•--- Address 1 J _ _._.— _Az - -- --- - ------- Phone---. LP� pl..�.. A .A..�_t, ,�-----I�� R - Contractor's Name_------------.-_ __---A.(R,�,1.5. _ �- . -9-./1).S..�.....�/11_C. ---..... Phone—a- ."fb Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel Number of livingunits; ❑ Other ❑ - Number of bedrooms,Q40 Number of baths4-49 Lot size - Water Supply: Publics stem PPY� y ❑ Community system ❑ PrivateX Depth to Water Table TQ. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan E] Previous. Application Made: Of yes,date...._-_...__. __. .) No X New Construction: Yes ❑ No X FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic lank: Distance from nearest well------------ ---Distance from foundation__-_._____---•__,Material.._____________________ ❑gkO1; ""No of cam artments . .------ p ----------- -------Size-------------- --•---------Liquid depth..........................Capacity P tY Disposal Field: Distance from nearest well.10SL 0__..-Distance from foundafion._/Q___`r__-._._..Distance to nearest lot line___7,57'.____ Number of lines_.�:yt,R..-. � �! ___ Length of each line_._,._,�// Width ,�r/ j T �t dth of trench. - ----- --------- ---- 3 Type of filter material._. Q-C_ Depth of filter material..__ .__ .L-$____..__._Total length-_._. ----------------------- Seepage Pit: Distance to nearest well.-.-20-v-__..--Distance m f ndation_._ �( Number of Its.._. �� ,�� Q•------.Distargce to nearest I t line_ -- c5` P 7---------- Lining material__a Size: Diameter__41 >� Q -- - --- -----...Depth--- - ---------------- 0 --------- --- �esspool: Distance from nearest well__ __Distance from foundation.-_._..-_.._._. -- Lining material___ \, - `( ❑ Size: Diameter..... - ------Depth------•-------- --------------------------------_-Liquid Capacity--- gals. Priv _ _� 9 ❑Y - Distance from nearest well____________________________•• _ _Distance from nearest building------.__.......................... �Distance to nearest lot line._....._. Remodeling and/or repairing (describe):_..__. - I hereby certify that a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d r es and re ulat' s of the San Joa n Local Health District. (Signed)--...------ •-------- t f ----------------. -- -------- - - - ------ By: --- . - -- --- - ----- - --------(Title) - r n r Contractor) ne a o or ___ {Plot plan, showing size of lot, location of s stem in relation to ells, buildings, etc., can be placed6n reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............. - DATE. .l-.7. REVIEWED BY----------------- --•-••--- ------------ •- ••---- ----.. DATE--- BUILDING PERMIT ISSUED.-------•------ -----------------------•---- - - D TE Alterations and/or recommendations:--___... t.----._. - - ------------------------------------------- ----•---------. . INAL INSPECTION BY:.. Date..... d ^�7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaiel►on Ave. 300 West Oak Street 124 Sycamore Street Stockton,California 205 West 9th Street Lodi, California Manteca,California Tracy, California F.F.C O. 1