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' ��APPLICATION ��FOR ��SANITATION ��PERMIT Permit No. u�..'��..��/ ._ (Complete in Duplicate) Do+n Issued/- Application '/\ |i ti is hereby 6 to the San Joaquin Local Health District fit 6 install hk herein described. This application is made in compliance with County Ord' ance No;/7.-'Y JOB ADDRESS AND.LQ,,CATION---------C�g /�' -----------� ------------- ------- ---- ------ --- -----------152_�LAf........ Contractor's Name------- is ----------------- Phone--7 -�-Wz77------- Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel E] Other E] Water Supply: Public system X Community system -[] Private E] Depth to Wafer Tablelx- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam Clay El Aclobex Hardpan E] twu Previous Application Made: Yes E] NoX New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or meyopow| pw,nn|He6 if public sewer isavailable within 200fee+J � Septic Tank: Distance from neu,udwoU-_----Disfunce from foundation-------------------Material ------------.-----.- n No. o[ comportmxots---------------------------Size--------------------------------Liquid depth --.-------.Capacity.--------- Dispouu| Field: Distance from noorv` well----------------- from foundation--------------------Distance to nearest lot line_-__._ [] Number of lines-----------------------------------Length of each line------------------------------Width oftrench------------------------- - ---- Type -Type of filter material------------------------- of filter mo+eri°L-____Tnta| length-'_..__--_-.__'---. 3o e Pit: Distance to nearest welL'_=--_------ ~��---. to � Number of Lining material---4FX!jC4((d-S-ize: Diameter- --rr------- Cesspool: Distance from '~~'^=' ~~'^ Distance from '""' d"'= L""'y material 11 -------------------- ----------------------------------------------------------------------------------------------------------------------------------------- -------------/----------------------------------------------------------- --_.-_''__.-___.__-.______--___.--___.._-___.___.-___.--_-_______..__-'_-_-_-_-_-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,-:�f�es, and rules and re"a i ns of +he San Joaquin ZLo klHeal isfrict. r----(Owne:r ga /ar �ontracfor) Bv:-------------------- _______ (Plot plan, showing size oflot, location of system in ro|mtion ��nUo. 6uY|6-ng�. o��. can be p|acUl on reverse side). FOR DEPARTk4ENTUSE ONLY APPLICATION ACCEPTED -------------------------------- - ------------- ----------------- -------------------- DATE~^ REY|EW/ED BY----------------------------- --------------------- ----------- __________ 8U|L0|NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE''' ------------------------------------------- Alterations -�''''----'-_______ AKpr Mono unJ/n, ,ocommenJuions:-----------------------------------------------------------------------------------------------------------------�_'_--_________ ---------------------------------------------------�''''---'''''----''''-_''''''__.''''----''�--_'''�'�----'--'__'--'__--------------- '----'-------'----'---------'---�-------------'--------'----'------------'---- -----------'_-----_------__��--__��______---------___---------'---_-----------_--_-----_--____-----_--______---_---___��__��----_---__-----__-----------_---- --------------------------------------------------------------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------------- RN/\L INSPECTION BY---. _i-�/--------------------------------- Date-___»---_ �� r~_ .��_..a��_____.___.� SAN J[AQU|N LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California rm=. California so--9-2w 8'5/ new/"°d W-2/00