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rvrc url-lut USE. ----------- ------ -------- i1--- . APPLICATION FCFR 'SANITATION PERMIT 40""/ Permit No. .rS-�� - - ------- --- ----- -- {Complete in Duplicate} ...... ------------- ---- ------ H - This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby madg1to the San Joaquin Local Health District for a permit to construct and install the work herein de I This applicatioD,is ma8e in compliance with County Ordinance No. 549, scribed. r JOB ADDRESS AND L CATION._ ' .,.-- Owners Name-____ Address---•-••---•-_ " ------- - ----- ---------------- -- Contractor's Name • --- - . --- -- -- ---•- Installation will serve: Residence Apartment House ----- Phone._ �-(g I, ❑ Commercial ❑_Trailer Court ❑ Motel [] Other, ❑ :� Number of livin9 __-_ rooms units: __ . Number of bed - I ❑ Community Number of baths Z.." / Water Supply: Public s stem �--.Lot size _�,��-�w--,�{ -�---_ - Y .I� system (� Private Depth to Water Tabie 2-!;-ft Character of soil to a dep+h';of 3 .feet- Sand ❑ Gravel`❑ Sandy Loam f] Clay Loam X, Clay ❑ Adobe El Hardpan ❑ Previous Application Made: 'I[If yes,date-------------- ) No New Construction: YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ PHA/VA; Yes ❑ No K (No septic tank or ces:pool permitted if public sewer is available within 200 feet.) Septic Tank: m Distance from nearest well.A)VA/�-Distance from foundation_.`Q♦ \ 'I Materia] -- O. No. of compartmentsa Size_ `7C.. {K S�- f !I ___-- Liquid depth---,S'Z't - Capacity---17_4_747 4?xr_e. from-nearest well_�0 _�Distance from f --- --------Field: NumbeDistancr Distance to nearest lot line__---- �! f -- ---Length of each line-_.- Q,��C, rr Type of fi}ter material-_ __ t --- Width of trench 0- - - ------Depth of filter material--- f�.-- -- Total �}_----_-- Seepage Pit: Distance.do nearest well-Aft Distance om f ndation ._ Number of rts. . 1f------.Distance to nearest jot line-- of yG` - .._Lining materia]_-__ , Size: a �( Depth_.-,C�J_f- ; Cesspool: Distance from-nearest well ............. b Distance from foundation._---_.--_------ Lining material..-----.-_---------_ ❑ Size: Diameter- -- ------------- ------- -----Depth-- --- ----- -- ------------ - - ---- ------ Priv ------------- ------Liquid Capacity-- ---------------- 9als. Y: Distance from nearest well................................... i -------------Distance from nearest buildin ❑ Distance to nearest jot lire_ g-------- Distance to' ------------ ji Remodeling and/or repairing (describe):--._---- ._ _-. - ------------------------------------- -' - 1�- - - ---- '_. j�l; --- -•- - ------------------------------------------------------------- --------------------------------------------------------------- ------- I hereby certify that I hav prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, n rules and regulations o ;he San Joagtai ocal Health District. { (Signed) t it _ ® ----------------- --------- -(o --------------- caner and/or Contractor) (Plot plan, showing size�o__tllo�ttioys+em in refs on to wells, buiidin s et Tale - -- -- 'i. buildings, c., can be pla d on reverse side), If, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_��__' --- t `' - �'. REVIEWED BY--------------- -.- --- ----------- DATE--------k-�-o��- �9 -------- DATE------- ------- UILDING PERMIT ISSUED-------II-- -------------------------------------------------- -------------------- Alterations A ----- -- and/or recommendations: --- -- ------------- --: : : - : :i-- - : ----------- -- --- -- ------------------------------------- - ' ----------- __ ------ - - ---------------- FINAL INSPECTION BY:.._ _- ' -- --------------- --------- Dat -1�, SAN JOAQUIN LOCAL HEALTH DISTRICT ,.1601 E.Ffaieltan Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California ' 20.5 West 9th Street E.N.9 2M 1.67 Vanguard Press Manteca.caliFornia Tracy, California r If