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Yr{ -" � U - APPLICATION FOR SANITATION PERMIT permit NoS� (ComNo. in Duplicate) ! q Data Issued _S' ` 5 Z - pp ication is herebymade to the San Joa uin Loci) Health District for a permit to construct and in Y This:application is made in compliance with County Ordinance No, 549. stall the work herein described. ""JOB ADDRESS AND LOCATION- ------ !== ? Owner5".Name ash ---- age 4Add ----- -------- ---- ontrreascstors - --------- N ---------------- ---- ------- -- hone • - ------------- ------------------------ame• 31a --------=----------- ---- _ lnstallefion will serve: Residenc ---------------------------------- e --- --- ---- Ph Apartment Houseone--3,�3-955-------------- --F'Number of living units: _ _Number of bedrooms CN tuber+al of 0 Trailer Court - „,. g ❑ Motel ❑ Other ❑ Charac euPPIY: Public system the -----I- Lot size • © ' Community system 5_QXjQQ - Y. �] Pr+vafe ________"_-_-_ - -, r of soll to a depth of 3 feet: Sand ❑ Depth to Water Table _-_____ ft.' '„i Previous'Application Mader Yes Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay [] Adobe Hardpan ❑ } NPF �F INSTALLATION AND SPECIFICATIONS:❑ New Construction Yes ❑ No F• a 4a. (No septic tank or cesspool permitted y if public sewer is available within 200 feet,) 4Septic Tank: fik Distance from nearest well __________Distance from foundation______-______ _ ►`�TG No. of compartments___._ Material__Size Nj oral-Fie=d: Liquid depth-------------- ----- ----------------- >: � Distance from nearest well______------------,Distance from foundation___:____-_ -- -Capacity_______ -- ---------- ------------------------------- ------------ z` NG' Number of lines_-___ -- -_ Distance to nearest lot line_ _______________ ------------ --Length of each line----- ___-- - _ Type of filter material---------------------- Dopi"h of filter material__________ Width of trench-------- ---------Total length ------------------------ Seepage Pit: Distance to nearest well_ ___ ________ T C7--------__-Distance frorn foundation--_____10-----_,Distance to nearest l t ine_-__•___ '�f s F; Number of pits-- ------Lining matar�al.-__ ?z' cesspool; � -___Size: Diameter___ r Distance from nearest woll-----------------Distance'from foundation--___.__-_ AR Li De th � �. ❑ ' _ Size: Diameter_-----------•-- --- - IV ---- ----- Pnv -----------Depth_ Lining material-- -- -- ------ --------- y Distance from nearest-well _ __ _ __ - Liquid Capaaty_ _ a D+sfance #o near" _.ne--. - _�_Disiancc from nearest building" arest lot Ifne -� ��—_- _ -�..�.�.w . ----------------------------- . ----------------------- Remo elfin _ g and/or repairing ( escribe): er_ _ical and =- ---------------------- --------- `- �k -up----tom �xis_t_� --------- ------- -+t z U e - - - --------- -�----- �� _----------- -------------------------------•----------------1------------ - --- --------•------------------------ --------- w ------------------------------------ ------ » <: I hereby certify fhaf I have prepared this application and that the work will be done in accordance with ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict San Joaquin County (Signed)-- Delta - ---------------- -------------------- - - ay:. = Pe rr_- _w_ar th T� '�, -----------------(Owner acrd/or Contractor) (Plot plan, showing size of lot, location of system in re Non to wells, buildings, etc. .ca - _ -- (Title)------Dwlie-T-Ttldgr- ' n be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- -__- -_-_ -...REVlr;WED BY _ -_ - DATE__ffi --- - ------------------------------------------------------- 8UILDING PERMIT ISSUED ---- ----------------------- - �' ---------- ---------- ------------------------------ _ DATE-------=- -- .Alterations and/or recommendations: '____--- I ---------------------------- --------- - ---:--- DATE--------------•--"�----- -` ------------ --- -------------------------- -- ------------ ----------------------------------- ------------- --------------- - ------ ------------------•---- ----- -------- ------------------------ ---- - •- ---= FINAL INSPECTION $Y:- J - ' f ._, --- Date------------ -- -----------------------------------------------, SAN JOAQUIN LOCAL.HEALTH bISTRICT 130 South American Street Stockton, California 300 West Oak Street i 132 Sycamore $free} Lodi, California 814 North "C" Street Manteca, California ` �;4--2M B-51 Ravisad W-2100 Tracy, California