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FOR OFFICE USE: V APPLICATION FOR SANITATION PERMIT Permit No. . � t (Complete in Duplicate) Date |xoue6 �$�} Application is hero by made to H`�S*n Joaquin Local Health District for u permit to construct and install the+howoherein described. This application is made /n comp|mncn with County {]nJinmnco No. 549. . JOB ADDRESS AND LOCATION--------��.��/�-----�..��--..�[±L��=.k!�..�9--------.-----------_------ [wmor', Nome-..-t~�.^.�-.-._--V0Y) R -------------------_'''-'--'''--''''_-_------- ------ phonu14L2A Address------------------- Contractor's ...... SOy��.—..i.��----__-__. Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [] Motel 0 Other � Number ofliving uoDb` -J Number of 6o6,00mo --7---Number of both, -I- Lot size ---(.__6...... ___-- Water Supply: Public system 9 Community system [] Private E] Depth to Water Table 60 ft. Character of soil to m depth of 3 feet: Sand 0 Gravel [] Sandy Loam E] Clay Loam E] Clay El Adobe X Hardpan � Previous Application Made: (If yus.6uh,-----------------) No;K New Construction: Yes [-] No Ur FHA/V& Yes [] Nox TYPE {}FINSTALLATION AND SPECIFICATIONS: (No septic tank wrcesspool permitted if public sewer isavailable within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --------''------_ [-1 No. ofcvmpartmenf,--------- ----Size--------------------------------Liquid cleF�k--------------------------Capacity----------.-- Dispos | Field: Distance from nearest weL--------Distunco from foundation--------------------Distance to nearest lot line_.--�--- 171 Number of lines----------------—''�'-'-Length of each ||me-'''-''''—-------Width of french---------------------- ` Type of filter material-------------------------Depth of filter material----------------- -'Tot | length'''-'_-'-''-_-'''' SeepagePit: Distance to nearest v;U. ��-'Diston m foun6a+ion-,��%�.-Di,foncofo nearest lot line-..)`I-..-- 1�[ Number of pits--..1----Lin;ng material .�Z<"-/K.---Size: Diomo+ec-A3..........Deo+6------------� `-.--. Coep6bL Distance from nearest well-----------------Distance from foundation--------------------Lining mu+e,io|------------. � [] Size: Diameter--------------------- ----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from n*oro, well_'�-'-'''--'''-''--Distance from nearest building------------------------------------------ F1 Distance to nearest lot line---------—._-.--------�.--_.__--'_--_---.—._----------� oemo6r|ing and/or repairing ---------19 ------ --------- t��-------------------------------------- ' ---'---------------------------------'-------------------------------' J� ------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------� ---- ------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | hereby certify that I have preparedthis applicationand that the work will 6edone in accordance with San Joaquin County . ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Jbo- - --------- --------------------------------------------------- and/or Contractor") By:-------1'L.1z_=.-'- ------------------ ---- (Title)-- ............. - ------------------- - - (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 APPLICATION ACCEPTED BY----��..��4c�~- --------------------------------------------------------- DATE.- .-----------,--------v REVIEWED 8Y----------------------- ---------------'_-_-_-_' DATE--._----_-.__-_____ BUILDING PERMIT ISSUED--------------------------------------------------------------_-------------------------------------- DATE---__-'-_---------_ '` ~ Alterations and/or ' ___ __�_________________________________________ � -�-��_'' _��-�� _'�__'___��'__�__'�_'' ''-''-'�--''-''--''''_'''--''�� - ----'''--'---_''-''''---'''-''-'---''--'''--'---'_-'_--- .--'-'''''�-'�—',--''''---'''--'� --''--'''--_'''_-'''--'--'''--'''--''--''--''-'''---- , F|N/\L INSPECTION BY:---..u',��w�l��----------- Do+=-��v�~��-.��e�---------------� SANJOAQU|NLOCALHEA�HD|SJR|C� 16wvm.*m,wm°Ave. xnovv�,Oak�~� 1z*w""m"�S,�w onowm,,v�m=", Stockton,California Lodi,California m""m"".o"om,"/" Tracy,California "° ° REVISED B-59 3M 3-'63 ,==".