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\ . Y�r APPLICATION. FOR SANITATION PERMIT p*nn - 3 J9_3 � Ilk' (Complete in Duplicate) Date Issued ^ m� pt 1 /' Applic'.;tion is hereby made to +he San Joaquin Local Health District for a permit to construct and install the work herein described. 'This applicatio ' '' ^'~~~ in compliance^ with County ~--- ~ JOB ADDRESS ,"`" ' °°"",^ .,"""^ �=o=��"x ^ *- - ..�-----------------.. Phone----------_~-------__- AdJ '--'--'--'------'- � Contractor's Name------------L"Wm%_---------- --------��-_-._._.--_-_ Phvno ..__-_-___--- Installation will serve: Residence Apartment House Commercial [-] Trailer Court [3 Motel F1 Other Number ofliving units: --- Number ofbedrooms r- Number ofbaths .1- Lot size .. � �� ' __-- VVater Supply: Public system Community System C] rPrivateF-1 Depth foWafer Table -'-- f+. ' Character of soil to a depth of 3 feet: Sand [� Gravel [] Sandy Loom [] Clay Loam Ej Clay 0 A6o6o��' Hardpan [] "�x » ` Previous Application Made: Yes [] No N Construction- Yes [] N ' TYPEr OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is availa6le within �00 feet.) Septic Tank: Distance from neares� well__!-��Disfance from foundation------149-------- Disposal Field: Distance from nearest well--- Disfance from foundafion---,/40--�""-.---.Disfance to nearest lot line---j7-1--- Num6or of lines-- Length of each line-------4i�.A--------------VVi6+h nftrench-------Z-------------------------- Type of filter mo+er�o pth of filtermaterial _ u ��.'.. .T -_ u�u| |enof6 -6 --- ------------------ | Seepage Pit: Distance to neareO well ------_----------Distance f�om foundation--------------------Distance /onearest lot line------ ` F1 Number of pits------ moteriaL'''---''S�zo: Diameter -'''-'-'-Depth''--_'--'`'_-�- C==sovo: Distance from nearest well _---_Distance from foundation--------------------Lining motori=L--.--.____.- [ [1 Si7o: D�ame+nc----- ------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals, ° U Privy: Distance from nearest well ''�---''--''''-'''_'Distance from nearest building__�_�'��--.,_-�'_-� � / El Distance tonearest lot line`'''_'.''''-'''---'-'''-_-'---'''-----_-'_---''-_'-'''''-'--- � Remndelinq °nd/urn,poir�nn (describe):-------. �j ..-------------------------- - ^ __-'__. -'--'--''--__'''-''-'-_.-_�-'_--'''-'---. --- --.-.---_--.-_-_---..-.---_--_---_----------.. . ---__-__-____---_-___---__----__'.-_._--__.---__----__-'---_-___-_.--__-_. � � ' '^~^~, certify that prepared this application and that fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulaflion's of the San Joaquin Local Health District. Ael By � ~ ~' ~ , r_^' ~~~^,, ~ ~' ~''' ~~~'~~' ~' ~r'~^ in relation to wells. buildings,^ ~`° can be placed on '~`~'~~ ~~er - FOR DEPARTMENT USE ONLY - U APPLICATION/ACCEPTED BY------------- - -_-__---_---- DATE----- �-�� ---------- RB0EVVBD BY------------------------------ '��'��`-. �'--��_-- ---------- ------- DATE'' ��'----------''-----__--__.___�_ ' 8U|LU|NG PERMIT ISSUED'_-.'_-.---'-_-''�--''-'''_-'�._.-. ---''-_-' DATE'-.-_-''-'''--''-�_._______ ' AJ*e,a+*nson6/o, nevqmm*ndaHnms:- - ---- ---------------------------------- ------ ______._ U -----------''----'--'--''''T--�y''----------------''~~-�--' ----��--'------- '--------- ��_.�-�-__---_-''_�-�-��'-_-''-�� _'��- ��''-_-'---��'��-_-"~-_'-�'�'''�_'_-'-~''--__.''-_-'_- --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------ ------------------------- ------------'''------ ---------------------------------------------------------------------'-'''-_.''-__- U FIN/\L INSPECTION 0Y;--/��'��7��.�'__-_�---_- �o��-��--.�-_-.------_--.-_--- SANJOAQUiNLOCALHEALTHD|STRICT / | /30 South American str°.of 3ooWest/Oak Street /s« Sycamore Street ow North 'C' Street Stockton, California . Lodi, California Manteca, California Tracy, California | ES-9-2M 8-51 pv"una vva|oo '