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APPLICATION FOR SANITATION PERMIT Permit No. 4"~ / ' ' inDmplicateY Do+o 1saua6 ----V-1 1- -.-- Dy a,e6v mo6o to the San Joaquin Local Heu|H` District for u permit to construct and \ �n�uUH`=wor' herein described. 's 6 ' ,|hiapplication i, moJa in compliance with County Cn6i o. 549. JOB ADDRESS / ` � � � - ---.---------_-_--_' ^=nvrn xomo --------.------. Phuna",�G-4-�/ --- Address ....... A66nao-_.-' ____________._____________________________ Contractor's Name------------------- .. _._________------ -.~� |mtallation will serve: Residence Apartment House F] Commercial E-] Trailer Court F] Motel [] Other El Number ofliving units: /- Number ofbedrooms /.- Number ofbaths ./-' Lot size - ^~~X.' -~ _-_-- Water Supply: Public system X Community system [� Private [] Depth to Wafo ft Character of soil to a depth of 3 feet: Sand [-] Gravel F] Sandy Loam n Clay Loam � C|uy El Hardpan F Previous Application.Made: Yo, [] Non�" New No �� " ' ^-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer i, available within 200feet.) ' Distance from nouroo+ wo| Distance from foundation--- 2�-«-..k4 ioL�� .�-..� --.- ��~�� No. ofcomp��ont,--'��-----Sizv-^�»'v-.----'_-�qui6 6vot -^�^.^----.-Copo6t�--------' Disposal Field: Distance from noune,f ~ Distance m noon. . --Dino to nour�� ^lot line-.47. ^Num6nr of lines- ------------------ Length of each line----------- ~ ^- Width Tvoe of filter mutorimL� Doot of filter material jiv-Tot | length ----------------------------- Seepage '_-__.'Seepogewell P�� Distance to nearest °oU-------'D�t Distance from foun6o6on--_--_-_Di��ncofo nounst lot line'.-.__- [] Number ofpits----------------------Lining material _-----.-Size: Diameter--_----Depth---.---_--_' ` Caopoo|: Distance from nearest well------------- ---Distance from foundation--------------------Lining mufariuL-.--_---_'__-� [] Size:� Diameter --------------------------- -------Depth------------------------------------------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------- ----------------Distance from nearest building---_'__-------- 0 Distance tonearest lot line ----_-------'--------.--.-__--_ � Remodeling and/or (do,cnb4 ` -- _-_.__.___------__-'-_'-_-_-'_-'_.._- -- --. � ---'------'--------------------'---------------------'----------'--' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �and/or�Conlraclor, (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 An=,anon» and/or recommendations:------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- ------------------------------ —_''-__---'-_---_--''-------_---'_-__''''_--__--_.--.-.--__^-_-' ----'—_-----------.----.------------_----__-'-------------'_-._---------___- RN/\L INSPECTION BY:.. ------------- Dmtu----`,-_--~.-�-�� -----.--.___ SAN JOAQU|N LOCAL HEALTH DISTRICT /yo South American Street mmWest Oak Street oz Sycamoreg*vv uw North "C" Street Stockton, California Lodi, California Manteca, California nu,^ California