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FOR OFFICE USE: --- -- -------- "--- APPLICATION FOR SANITATION PERMIT Permit No. ..-.---•.------ ----------- i----------_--_ jrrl�plete in puplicate) F Date Issued This Permit Ex ires 1 Year From Date Issued -------- ---- - Application is hereby made to the San Joaquin n{calONdenB}nceDlNoC} for 49 a 1permit to construct and/install the work herein escrl e . pp This application is made in compliance with County y( JOB ADDRESS AND LOCATION----- ------------------------------ Owner's -------Owner's Name-------- -��r-r---- ----------•-----------•--•--•----•------ --•------------•----.. Address----- ...... ........• ` ----- ------ � -- r F � '.t.. ---...---- Phone----- = -•�-� ..... .. Contractor's Name_.:J-/ --- f Mote; ❑ Other ❑ Installation will serve: Residence; Apartment House ❑ Commercial ❑ Trailer Court ❑ I 1---,Number-of baths__/---- Lot sized 3`-.1. Number of living units:"_t__ Number of bedrooms }h to Water Table ft Water Supply: Public systema Community system ❑ Private.❑ Dep I Cla Adobe,� Hardpan ❑ 1 f Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ _S3ridy Loam ❑ Clay Loam ❑ Np Clay [3 ❑ No ❑ [ C New Construction: Ye ❑ + Application Made: (if yes,date No,❑ r f Previous App { R, I TYPE OF INSTALLATION AND SPECIFICATIONS: � ; I (No septic tank or cesspool permitted if publi`sewer is available within 200 feet.) �,/ ------ �r > �0� --Material :,.c*is - ---- - No. of nom arneares �,�'from foundation-.. _. r p Tank: Distance from nearest well�_4-�� - /� � - Ca aci} -tp � 'P R -�----Li uid depth._��--1 - ---- - p t Y- istanc i Se tic _ ""' Size.. -'r q 1 nearest well .. QI L/--Distant ,r°m.four da}ion---. Distance oto nearest lot line--f-C'--r.-- T p �p r _o Disposal Field: Distance from44-6-Z----------- trench.__ ------f -h j Number of Fines.a..�------------ ------------Length of each line., -- _ k "1 Total 1'ength- C Type of filter materia ,,,- -------Ddpth bf'filter�-matenal__._�f --- U r Distan e from foundation_ t.d_._......Distance to nearest lot line...__ - ---- ` ..� Seepa a Pit: Distance to nearest wel!_ -- Q o_f�. Size: Diameter-1,,3�-------------Depth-,2�{71------- Number of pits._.__.._.._-_------Lining material "1 Distance from nearest well ................Dis}ante from foundation __....__.._.. -- -.Lining material.._....._........_...-------------- i Cesspool: --------- -------------------------- .-Distance -----.Liquid Capacity- ----- -------------------9als. ' --- ------- Depth--------------- --- ------------ - -- ---- ❑ Size: Diameter. .. .-- Distance from nearest building__..--_-------------------- - Privy: Distance from nearest well----- ----- ---- ------ - ---------- --------------- ----- ❑ Distance to nearest lot line ---------------------- - ----------- r -�T --- � ----- --'- - - l - Remodeling and/or repairing (describe)j_ T 7` ---- --- ----------------------- ------------------- -- ------------- 1 GGA- } C - ------------------------------ -----.- ----- ------- ---- - -------------- ----_---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of he San Joaq 'n Local Health District. � ffmn9p41- Contractor) er ► (Signed) ' = --- (Title)--------------- ---- ------- Sy----------------------------- (Plot plan, showing size of lot, location of system in refs on to wells, bu' ings, etc.,scan be place on reverse sl e. r FOR DEPARTMENT USE ONLY --------------------------- =t DATE-------== 1 g------------------------ APPLICATION ACCEPTED BY----- .-- i` --------- -- REVIEWED BY------------------------------------------------------ ------------------------- ------------------ ------- -- DAT --------------------------------------------------------- ---- -- --- ---------- -------------------- - ----- ------------ ------ -------------- ------- DATE- - ----- ----- - ------- ------- --------------------- BUILDING --- --------------- BUILDINGPERMIT ISSUED---------- --------------------- -------- ------ ------ -----I------•----------------- ----------------------------- Alterations and/or recommen ------ -- -- -- ----- - --------------- a ions:.._..----------- --- --- - -- ---------- ---------------------------- _._....-...----------------- ---Jr'f-----....--------- . --- ...-... V --- . � ------------------------- BY: . I FINAL INSPECTION BY.. -' _:.- U- =' Date- ---- --- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 West 9th Street 16o1 E.Hazelton Ave. Y, Trac California Lodi. California Manteca,California Stockton,California E.H.9 2M 1-67 Vanguard Press ,