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FO�R Orr-ICE USE: --------- APPLICATION FOR SANITATION PERMIT Permit No, -��.--1•-_--- _: - - {Complete-in Duplicate) ----- '-------- ----------- ZsPermit 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 install the work herein described. This application is made in compliance with Gounty Ordinance No. S49. 2d7OJOB ADDRESS AND LOCATIN _ . e�_._✓�a ®_ Lt Owner's 4Name- -- - �.. -- - _._. Phone__gf, ,�V_. Address-------------------- :w . . i✓rz = ..----•--- -•--------------------------- ---------------•----------------------------------- Contractor's t Wit. Z4—,1 ----•---•------•--------•----•-------•--- Name-=--------=- - � lh'ai� .---;-•-•'--.__.._-- : - Installa+ion will serve = P -. -- one ---------------- +Residenfe Q" Apartment House ❑. Commercial��.tTrailer;C.ourt,M Motel ❑ Other ❑ Number of living units: __�----- Number`of-bedroom`s'_=,� Number`of�baths n j_ Lot siie .... _ __. _-- Water Supply: Public syster -XX Community system ❑ Private ❑ Depth to Water Table _( _ fte/Lzr Character of soil to a depth of3 feet Sand ❑ Gravel, _ Sandy -r r �{ /' �f - y. _❑ =•> ,ay,Loam.❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: (If yes,date____._._.___.---�__ ) IVa �f - NeNW Const-riicti`oon�Y ,Yes No ❑ FHA/VA: Yes ❑ No VTYPE-O�FJNSTALLATION AND SPECIFICATIONS:.. ,` ,-_. .; E (No septic tank or cesspool permitted if public sewer is available within 200'feet.) Septic Tank: Distance from nearest wel!_.'_----:_-- Distance from fou ndation----- _________`_..Matarial ' hw/ " No. of compartments- -- Size " ' m �/ -� ----- -.Liquid depth-------- - ---- Capacity--•------ l 'h Dis�pos%I field: Disfance from nearest well /�d!l�Distance,from foundafion_.*._f0.-_ -'.-,Distance to nearest lot line___S1 Number of dines.------------------J l---- ----Length L�e�rferial ' _�.--- x--.Width of trench 'eria of filter material7T._ 1P-__- _De fh oI ° p - Total lengt'n -,7T,t! Seepage Pit: Distance to.nearest well -e-------Distancn tion____ _-�_____._. tante o nearest tot e__._N°umber of{p ts... ....... .........Lining m'teria!__ Size: Diameter 46---.--Depth------007 4 Cesspool: Distance from nearest well ______________Disfance,from foundation._____--------.- . Lining material._....___-_- ' -r ---------------- ❑ Size: D�ameter- Priv i� - f}epfh Liquid Capacity.. .-- gals. t y� Dis#ante from nearest well______________ _______._ ❑ ___________________----- Distance from nearest building Distance to nearest lot line ... ..�-._.�...___ - --- --------- Remodelin and/or re aGin ` describe '.__ // , I •f a � �crr_rr _ ------- -------------; - - -- ------------------------------- -- - -- ------- I hereby certify that I have prepared this application and that the work will We done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.: 1 5i ned 9 ) - - r and/or Contractor) By: ................ - I T I ----------...------------------------------- -- (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 ACCEPTED BY----------------= ------------------_------------------------------------- DATE_ - _ ' REVIEWED—BY----- -------------------- ' - F -------------------------------------- --- ------ DATE -------------- 1 DING PERMIT ISSUED -- ---------- ---------•-------------- ------ DATE---- ---------------------------------------- ------------- Aiteratio�s and/or recommen ations:. --�- ` - f/ ----------- ----" ------ )------ ----- -.- _ ----- FINAL INSPECTION BY:..___ ` .......................... --.... ---.---- Date_ .. i✓ - - SAN JOAQUIN LOCAL HEALTH DISTRICT R 1 1601 E.Hazelton Ave- 300 West Oak Street 124 Sycamore Sir eet Stockton,California Lodi, California Manteca,California 205?West 9th Street ` s 5.H.92M 1.67 Vanguard Press Yracy,.Californio J