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APPLICATION FOR SANITATION PERMIT A (complete in Duplice I.) Permit No.,.r/.P.4 gplic -�ion is hereb a 's Date Issued -9/D,9!D Y Made to fh� San Joaquin Local Health District for a ..,--------- application is Mad, in compliance with County rrnif _7--- Ordinance No. JOB ADDRESS AND LOCXTJON......3 S-/ > 4 to construct and install the work herein described. Owner's Name ------------------- P Address ------- ---------- -4.jj�tx 4/ -------------------- \_7------- ---- - ---------- -------------- Pic,--------- ------------ ----- Phone,� - ---- ---------- Contractor S Name--- --------cf 72L ------------- Installation Will se,y ------ e: lResidence H --------- --- Phone- Number of livin6 units: Apart en Ouse commercial Of V # ---- ---------------------- Water Supply: publij Niu�mber of b, Trailer Court Ej mofel 0 Other E] system 0 , ... Number of bafls /�__ Lot size Character of soil to a depth community s,y�fam ED Priva te of 3 feet CK Pepf� fO'Wafer Table --------------------- Ise 'and El Gravel Ej I Sandy Loam Lj Clay Loam 0 Yes El, !�..vPrevious Application Mad, ft. TYPE OF INSTALL �O X New Construction: Yes 4 No. I E] Clay ID Adobe Hardpan [j L ATION AND SPECIFICATIONS (No Septic fank_or cesspool permiffed if pu Septic blic Sewer is avail i able within Tank: Distance from F - L_ 20 nearest well r 111 0 f t.) No. of Comparfm ----D;sfance fr Disposal Field: ants-. 7L-------- _SiZ� 4 om 00n fion-- -----I------- f om to 11 a er, -v,,T X---7 ijiliquid depth (41 ---------- 44�.of J-------- ---- Cap Distance from nearest weil li5_ .-Ii, --c-4)1�) Numbe 'Distance f ill r of lines--- ------ rom foundaf - ------- ad y--- Typ Length of cip-_��Z;PDistaric'e -------------- t ea to'nearesf lot line --- ----- --- _.- e of filter maf,,`ia[_'�. . ......... ch [in,__7_,k3_ W.dth -f'fre, 'h Seepage Pit: ..........F'ft Depth of filter materl,L) C -------), y ----------- Distance to—neare-stwell. ---------------------Total length--' El Number of pits------- ...__-, rom fo.un�atio P------ DIS ZIB ------------------------- Lining material.... fance tc�nea,e cesspool: - ---- --.- Distance__f---- -Cm ne;resf well - ----------- Size:' Piameter-----------------------Depth ---------------- Distance f, I ----- sf tot fine - --Distance from i -------------------------------- S;ze: Diameter------------------------ foundation----------------------Lining material privy, ----------------Dept h------- ........................�1, El Distance from nearest well------ --------------------Liquid Capacity........................ Ill. ----------------------- ------------- _Disfanc-e from nearesf building .... Distance fo'nearesf fof line gals. ---------------- Remodeling and/or repairing (clescrib,j---------- ------------- ------------ .............------------ ---------------------------------------- -------------- ------------------- -------------I-------------------------------------------- ----------- ---------------------I------------------- ------I---------------------------------------------------- ---------- ------------- ------------------1--------------------------------------------------------------------- _------------------------------------------------------ --- ------------------------------- ---- -------------------------------_. - - ------ --------------- I hereby --------------- -------- ` -1 �� -------------------------------------------- ordinances, S afe laws, and rules and regulaf is-aPplicafion -----------------lk------------------------- certify that I have Prepared fh -------------------- f S and that the W A will '11; ------------------------------------I---------------- ions of the an Joaquin Loc 1 0 0 in accordance with San Joaquin County H b: r1cf. (Signed)..... ealfh:' isf�e --------------------------------------------------------------11 ------------------------------- (Plot plan -------- (Owner if le)---- ------------------------------ (Ti I showing size Of lot, location Of system in relation to wells, buildings. ef ---- ------------------------------ FOR DEPARTMENT USE ONLY an e Placed on reverse side)- ----------------------- APPLICATION AC�64UD BY--- --- ----:------------------ jj� ------------------- .... .. --- -- -------- Ile, 11 REVIEWED BY ---------j,---------- il, I ------- - - -------------------- ------ DAT! , I��i / BUILDING PERMIT ISSUED- --------------------------------------- ------------IL DATE 9---------------- Alterations and/or recomme ---------------------------------------------------------------I--------------------- ------- ------- ----------------------- ns---------------------------------- ndafio ------- DATE ------------------------------------------------------ ------------ -------------------------Z--------------------I'lli - ------------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------I-------------------- .......11: ------------------------------I---------------------------------------- ------------ ___A_1-------------------------------------------I-------- -------------------- -----------------I-------- --- -------------------------------- --------------------- . I -------------_------ ---------------- -- 4 7-------------------------- ........................... -------------------- ------------------------------- f-------------- ------------- --------------J.1........ --------------------------I--------------- --------------------------I---------------------- ------------------------------------------------------------------------Ili —-------------------- 11NAL fNSPECTION BY:.:,o.I A!fx -------------------------------------------------------------------------- .............. Date IOUIN LOCAL HEALTH D --------------------------- 30 South Arnorican Streof SAN JOA ISTR[Cf Stockton. Califormia 300 West Oak Sf,,.,,+ 132 Sycamore SJI' Lodi, Cargorn;, root 814 North ..C.. Manteca, Caljqo t Shoot 2M r.1a tracy, Cafffomia