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2 OFFICE USE: ............. APPLICATION FOR SANITATION PERMIT PermitiNo. ........................... .._...............•...... _-,-_ �•-- (Compls+e in Duplicate) Date Issued =�o ,,-..•-,_----_-_....._....' This Permit Expires 1 Year From Date Issued t ttion is hereby made to the San Joaquin Local Hetsl+h District for a permit to construct and install the work herein des( plication is made in compliance with 141/—, Ordinance No. 549. DDRESS AND,=ATION.��P� Z_G A4,M &W...I �I— 1 rr��s Name.....--- J.12.G-G-I-.�l . ..t- -�4h[.�G2..---------------------------._---------------.._.._.....-----•-•-•-. r� PPhhoonnee-..I.,.-.--..f..-...e. 2- s- ------------- ....._..----........._.....__...._.-------------------------------------------•--.... ---- alC .........._ :#pr's Name ...PT sY ..................... ' tion will serve: Residence Apartment House ❑ commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..--. Number of bedrooms .X- Number of baths---4 Lot sae ..ee -. 13 .S--- ---------- ' Supply: Public system ❑ Community system ❑ Private3< Depth to Wat r Table ...... . ft i Adobe Hard :ter of soil to a depth,of 3 feof° Sand ❑ Gravel ❑ Sandy Loam lay loam ❑ Cla ❑ ❑ Clay- Jr, el New Construction: Ye o ❑ FHA/VA: Yes ❑ a:iApp{icat'io^"151adei-(Ifyes,-date....- ) No ❑ ' 7F INSTALLATION AND SOK ANS: (No septic tank or cesspool permitted ifp''0ub�l' se7r is available within 200 fee+. / /_ rJ _i',Distance from fou igee--.-L_D._....Mater'alif...&_mr c�!�° ' fTankyV _ Distance from nearest well,.... �j �'--• •-- -SNIT: of cto}parYments..,�1--_'. Siz D (2.a•L� u dap+h---�....-.---..Capacity...�� PI Field: �Qis#ante from nearest well Distance from foundation....-,l.Q�Distance to nearest lot line.._. .. % lNumber of lines 2,_ '.. . '�} LLength ofeachline...,6t. ................WidtV of trench_.se1�S��!�- ' Type of filter mate 2c%yu+�;epfh'of'fil'+ 'r material........a �!-.Total length:..............IO..G 1 ge Pit: Distance to nearest .......... Dis+once from foundation..................Distance tb nearest lot line.... Number of pits.:.._.-.._......_.LininE .material-t-----........J.-Size: Diameter....._................Depth---------._..----- ' Dol: Distance from nearest well.--------------Distance from founda+ion....-_-_....-.;'..Lining material..................... Size: Diameter. .. ....-- ...................... D pfh...----_-- ..._.... ------.....Liquid Capacity--............-...... ' ...._--...Distance from nearest building......................_.. Distance from nearest well_-.._.._..__-...:.........._......._. ' ' Distance to nearest lot line-------------—...._.....--....-_-.--..._-------------—...........____-......._........................ 1. ._... .. - _ ..._...._ doling and/or repairing (desc'be):.......... ... Ns�'' 1 —... _. ... 46i _._- - ----._......................... ...... _.............----...-..._._._...-_�4__.._.._._...._ ...._-.�_...---.._----------------•--...._.__ - - - - ........--- -� ........_............_.... - .._. ' herebyy et certify that I have prepared this applica+ion and that the work will be done in accordance with Sen Joaquin Innes Sfes and regulations of the San J a inefu LocalpHe;ith,Distrc+. 1 }y. . .....17./...... ..._.--..------ Co Cj By:..........- ..... ------_---------• - ------------------------------ ----- (T clan, showing spa of lot, location of sys+em initiation elation wells, buildings tu, coli be placed on reverse side] FOR DEPARTMENT USE ONLY T KATION ACCEPTED } -- � --�- - --• - -•••-•"•-""-'"'' wED BY.----------•---------•- ' .............•-----------_..._..._......... ._. DATE ----_------- -----.--------------------- ' )ING PERMIT ISSUED_._..._( .. ----•--_._....._....._....._......--........ . .... DATE......,..__.._..... - - ...------ cfions ...- efions and/or recommendafiats:..................---.....-----...:................--_.._.._.._................r ......... __--------- _:---------------------- ........ . ....._.. -.......... - -..._........................_._.... ...... ti....._.....-........._. ....................._ ._.._ ............ ........._. r _................, _.._....... ........................ _.........� ....__._.... ....._._._.............. ......................................... •... . Date...... N bd.. _ .... . _......... ' AL INSPECTION BY:.040 --- 7k s. . . SAN JOAQUIN LOCAL HEALTH DISTRICT . 1601 E.Notation Ave. , 300 Wast Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,CaliforniaLodi,California Manteca°California �4+ Tracy.California 12M 1 67 Vanguord Press