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FOR OFFICE USE: ------------------ ------------ ------------ y� z lj_ r�r I APPLICATION FOR SANITATION PERMIT Permit No. ._.1.r Si6._ " .�!1'_ (Complete in Duplicate) Date Issued 1704 ------------1111 This Permit Expires 1 Year From Date Issued Application is hereby made tb the Sari-Joaquin Local Health District for a permit to construct and 'install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----- -1-1------ n+ IT ------------------------------- ----------------------------------------------- ---- ---------------------------------------------- -------------- -------- Phone_ +': _. Owner's Name----------- - - ----.ii------------- - -+•- --- f 1 ] Address-------------_-------•--A-3-3-� / Contractor's Name------------ - -- ------ - ---------------------------- Phone- 6i�_.- --- ... --- - - ---- -- Installation will serve: Resice Apartment House El E] Trailer Court ❑ Motel [:] Other ❑ dn Number of living units:: ----I_ Number of be .-')--Number - "�Number of baths ----I.. Lot size ------1-Q-- - - - ---------•-------- Water Supply: Public systellhL Community system ❑ Private ❑ Depth to Water Table _60- ft. Character of soil to a depthllof 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe Hardpan El Previous Application Made: u�(If yes,date--------........._-) No � New Construction: Yes E] No X FHA/VA: Yes ❑ Noo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ceslspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance`I'from nearest well_______________Distance from foundation-------------------Material_..._______....______.__________.."________.._. ❑ No. of compartments--- ---- - -------------Size--------------------------------•Liquid depth - Capacity_. I Disposal Field: Distance111from nearest well�-KADistance from foundation------l.Q.........Distance to nearest lot line___�__"________ Number sof lines---------•----J)----------- ---- --Length of each line----------cS------------.Width of trench----------- -�---------•-- — j " g q Type of.filter material5_.___- _X-___Depth of filter material----.___I_$'________Total len th----__._..__"___:__. _�. ---------- s Seepage Pit: Distance�to nearest well")% f'►_.k-___-_--Distance fro fo ndation___._�_�_____.--.Di`tance to nearest lot line----t _ ..... I Number' ,.-Size: Diameter.3-3-- Depth- h,umber�of pits.__._____�.__...____.Lining matersal�•._b._.___ - NI Cesspool: DistanCE I from nearest well---------_-------Distance from foundation.-------------------Lining material------------------.------------------- Size: Diameter---------------------- ------Depth--------------------------------------------------- Liquid Capacity gals: i ❑ l _Distance from nearest building f Privy: Distance nearest well__"- ❑ Distance�lto nearest lot line.----- .- --'----------------- gs'V0-11 0 C L .1�. Remodeling and/or repairi g (describe): 4'" +-� -------------------------------• `ty,� �."-------- ---------------------- 1 --------------------------------------- ----------------------------------------•----------------------- ...... -------- ' -------•-------- ---------�M-------------------------------------------------------------•---------------------------------•------------------------------------------------------------------------- -- -------------- M-----•---------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and1rules and regulations of the San Joaquin Local Health District. �_ _l Si ned - -------------------------------- --------------- -----------(Owner-and/or Contractor] ( 9Ii - ---------------------------------------------(Tit e)------------------------------------- BY -- ------- (Plot plan, showing size of 1&, location of syst in relation to wells, buildings, etc., can be placed on reverse side). �i FOR DEPARTMENT USE ONLY `---------- DATE--- Z �------------ ----------- APPLlCATiON ACCEPTED�l6Y ---L---�--��"�-- - --- -------- ----------- -----"--------• ------ ' ' ---- DATE-------- ---------------------------------- ------- BY--------------------- --------------- BUILDING - -- ------------ -------- --- ------------------------•- -•---- - -- - BUILDING PERMIT ISSUED -------------------------�---------------- -- DATE------------------- �- ----- -----------, ------- Alterations and/or recomml ndations:._--_-_..Z 61 �r`N� J` - y' �� ` -"r------" G �__ --- ------------- � � "' G ------------------- ----------------------------------------------------- -------------=----- --- -----, -----•--------------- " --- ----------------------------- -----------• ------------ ---------------------------- l; --- --------------------------------------------------- ------ ---- ------------------- - - ----- ----------------------------------- ---•---- --- ------- 'I 9PDate ------------------------------ FINAL INSPECTION BY:-G . � , i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Avg. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California