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/ -- - - ' - APPLICATION FOR SANITATION PERMIT Permit No...? k�umu� -� � `---- --'---' Date |oue6�-..��.��a�- ° v / '�' Ano||uuf/on is hereby mu6oto the Sun Joaquin Local Hou|fh District for u permit to construct and indn||the work heroin 6ua:r|6e6. This application is made in compliance with County Ordinance No. 549. ' -7'---�------'---------'----'--�'—'' JOB ADDRESS AND LOCATION----------- Owner N .-qPhone-_--_---__- ' - ' . fzv-;I<,- Contractor's Nom*--..____-___-_-.__._�-_-.__-------_�_--------_-.---- Phone--------------------- ------------ Installation .--|nstaUmfion will serve: Residence N Apartment House E] Commercial [] Trailer Court [] Motel [l Other El Number of living units: -/. Number of bedrooms X- Number of baths Lot size ------- ._—__--VVafe Supply: Public system E] Community system F] Private Depth to Wafer Table 5 ft Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam L] Clay E] Adobejo Hardpan � Previous Application Made: Yes [] No Ej New Construction: Yes P� No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer & available within 200 feet.) Septic Tank: Distance from nearest well-----P^-D|sfancnfrom ion--..,.0./-MuteriuL-.. .-'-_----- �� No. of compartments----��.------S�ze-��'��«�'��'�---'�qui6 6epfh--.�� " Capacity 15-00 -------- Disposal Fi66: Distance from _��'----Disfance from foundation -lb-']t_ ---Distance to nearest lot line----M2------- --------------------- Seepmge Pit: D�sfo well ` 0 Number nfpits--'''-''''Lining material----------------------- Diameter-.'''---''-Dnoth_'_-.--'--'-_ Cesspool: D��anca from nearest well------------------Distance from foundation------�ning matoriuL-�_-._---._.-- ~ [] Size: Diomafoc'--��'�-'-''—'-Depth---.''-__-_' -----------------------Liquid Cupac�y---''_--_'-'ga|s � Privy: Distance from nearest well------------------------ ------------------------D�sf°no, from nearest building--_-_-._--_---- U [] Distance to nearest lot line----- _�''�''-�'''—'--_-'__.-----'--_.__________________��_____ . . Remodeling and/or repairing k]uazibe\ ' ---'-------''---------'' ------- -^ '-------''---------''--�''--'r �~�''--�~'p'�+�---f�^+-^�°�+f --.___._'_'--._---_--__--_____~_-_'--.__.�__.____.___---_-_-----_-__-_--_--_-. 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 Healfh District. 7. /P�| plan, size of lot, location of system |� relation to wells, 6wU6' -- (Title)placed' etc., ��m6n ---on ------'--��---'- reverse side). FOR DEPARTMENT USE ONLY APPLICATION- ACCEPTED ~'-'�-'�-'''-'''--''' '--''-'�''--'''' ""'�-' REVIEWED HY_--_-'-'-'��''---'-''—'--''''��'�--'-'- D�TE- -�--'--'----- ---'-v--'�-----'------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE'''-'----__-'''�'--____-_ Alterations and/or recommendations----.-----------.-----------.---_----_-------.-_-_-__._____' ' '-----------------------'---------------------------------'--'_-_._- | '--_'--''-'-'''''__.''''-'--'''--��''''—''''---'''''''''''_---'''�-_-'---_--''-'--''_--''__-'_-'_--- ----------------'--------_____----------------------- ----------------------------------------- ------------------------------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------------------- �_�� __ _____________________�___�_________________________ F|N/\L INSPECTION 8Y�.� -------- Du+a_ - -------------------2-L-------.--- SAN JO4*Q0NLOCAL HEALTH DISTRICT ^ /ao South Am°ri"o" Street 3noWesfOak Street /oc svcvmu= s*=°+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California Es-9-'2u a's/ xe./""J vv'21oo '~~