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rVK UFFICE USE: - -� ----------------------------- -------------------------- -- ----------------------------- APPLICATION FOR' SANITATION PERMIT Permit No. --------------------------------------------------------- {Complete in Duplica+4, t ------- ----- --- ---------------=-- This Permit Ex fires 1 Year From Date Issued Date IssuedY- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. This application is r/ � mpliance with County. Ordinance No. 549. I�j po1� Q� / f�J 'J C 7 p-�V JOB ADDRESS AND L CATION(_Y_.SJ.� _ Ritep-a-,----�D_-'.- TW --W_ _A=M�}_:�4__,1 Owner's Name..-_'.__ Address-- �" I ----------------- - _f----------- •• Contractor's Name_:. _A1tp9,4.,,��Apartmenf �� }-+�QInstallation ill serve: Reside ce House ❑ Commercial t3 Trailer Court ❑ Motel 0 Other ❑.. }i;tFi"+� R r of'Irvmg units: _'_ : Number of bedrooms __ _ Numbl t_ 3 Number f baths _]___- Lot size } -, Water Supply:, Public sys#e ❑ 1Community sy em ❑ Private Depth to Water.Table _ . y • Character of1soil to a depth f feet: Sand, Grave! ❑ Sandy Loam'�Clay Loam 0 Jlay �Aclobe❑ Hardpan ❑ Previous App ice inn�Artade:.�.f yes,date-_____________ ____} No ""'New C ri�s uction: Yes moo,6Z A/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:. C_ : -' (No septic tank-or cesspoof:permitted if public sewer is available-within 200 feet.) Septic Tank: Distance from nearest well---50--___Distance from foundation__-.�O-------Mate i.al-.______�_______________________ Dis p � t osal 'Field: , Distance from nearest welt._..��-----Distance from Liquid depth_.. aCapacttY :.... 1 �-' No. of tom artments___---=----------------- Size: :-_-_= • ' � r p .-- - foundation__._. Dista Al to nearest lot line__ -...-- ./.�_____...D�Eta -_-______LeP th of each line.... 9 t }(moi-I Number of lines__ _ ____ �} aq D D T e of filter mat fial.....Ho C-�_De th of filter material----__�� 'Totalle of trench.___._rL�__�� YP e 9 Wrdn th__!_.-:-._:J�� g = Seepage Pit: Distance to nearest Y41 ----- from foundation___ d �._...__ Distae to nearest lot line___~—_�__ 'o� „ D' Number.of pi s____--__-- - inmg ma eFia1 ' f1G�' __ Sae: Diameter`�_X:.. __...: ePth_-.-•- -----•-----•----- ❑ Size: D.iamete ------- Dh �` � ndion - -__.Lmmateri�l ._.- = Cesspool: Distance fro nearest well__-___ .._ st nc from fou - T�'!�!Es q 4=------------ ----Li i;d Capacity------ :gals. 9 Privy: bistanre`from nearest well"' t't-� � Dista ce ---., -------------- --- .-- isf �t .from nearest building.- ------••-----------••-•--------------. ❑ Distance to nearest lot.line---.-- ------------•----- --------- --•---- Remodelin and or re ai'rin des#tribe ------------------------------•-------------_,-- ;--- _----- �, .: ------------• -----•----•----•----------- 1 s ..0 1 - - _____}__a______.-�_. ___________ _ ----------------- _______________________ _ -- _____ ____ ----------------------_________________________________--------------------------------___A---------------------------------------- ------------ : ,.I hereby certify that I'have prepared this application and that the work will-be donor in accordance with San Joaquin County ordinances, Staat I s, and rul '",and°r gul s of flys Sa Joaquin Local:Heaith District. t A gn - ---=- ----------- y - = --(Ow °_-- �a retract By----------— - -�- - -- - -- --{r±lel------ � --- -- - ----- or or (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc:, can,be placed on reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION tACClrPTED BY DATE.. f -`-G._''�1� ^• REVIEWED BY------••------- ""`h�� .Ptt. �l .- ! r . ..__' ._:_.... DATE_ = ._.. ' BUILDIiVG P€12A7f;IT1SS.lJPD .._..�x _ ,a� ', =, ,� ---_________ ' Alterations and/or,,recommendations: .. rye^j _ 1 . z —f -------••----•=--•--- -----•....................... . �► t rL --------------I------------------- t: ----------------------- ...' --------------------------------------------- ___________________ °L.. FINAL INSPECTI - --------- - ate------ ---- ------ ------- J - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 South American 5#re►t app'West Oak Street 124 Sycamore Street 265 West 9th Street „-- Stockton,California Lodi,Calffomia Manteca,California Tracy,California ES 9 REWSED a-59 2M 'Sr62ATLAS - t