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Permit No. .--- ' APPLICATION FOR SANITATI " late in�Du rc Date Issued -_---- - f (Comp _ t aliLfaC, fora a ermit to construcfi and install the work herein described. Joaquin Loco-4( --,,I �I ql't Or Ana . p,pplication is hereby made to the San Dance with Go � _ --- P licafiion is made in comp' This a p * ` . ._ ---�,,.�,�,------ Phone_----•------- ._. JOB ADDRESS AND LOCAT101 �.: ,, �---- --- -- ----- ---•- :' a- �;�. S 't�; --• Pho ----------------------- ------ Owners Name_-____.__----- ___ _ -_ --- n Address.-- -•------ r eOther ❑ Trailer Court ❑ el ❑ :. .� of Contractors Name__ ;fq Commercial ❑ Apartment House ❑ —'._�__ �.----------__-,-_ � Installation will serve: idence �� p Number of baths _- ----- Lot sae -' - ------- Private N,/ Depth to Water Table _75At• Number of Diving units: --�__-_ Number of bedrooms . Loam y ❑ Adobe Hardpan ❑ Community system❑ Cla Water Supply: Public system ❑ Sand Loam ❑ Clay ❑ Gravel ❑ y FHA/VA: Yes ❑ No ❑ Character of soil to a depth of 3 feet: Sand ❑New 'Construction: Yes ❑ No., lication Made: Yes ❑ No" � Previous App ✓ ' TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within 200 feet.} k A p P C (No septic tank or`cess ool ermitted '+ public foundation__�`_----------.Material`--- Capacity_ Distance•from•nearesr well -_ Distance °� GTf c� Septic Ta _' -----Liquid depth----_---- No. of co mp&tmer+ts_____-.___ �v Distance from foundation _- --_-----Distance to nearest lot lin jf_ --- Width of trench - Disp�osa/l Field: Distance from newest well.- Length of each line-----. } !i'--__ G s h�' Number of fines___.`-- ._Total length---_--- _. ---Depth of filter material_-__. _ Type of filter matenaL-_- pistance to nearest well__'_ _------- 'Distance from foundation-y____.--•---• -.Distance to nearest of sne____-__------- r ptb Seepage Pit: material -- 1 ----------------- ------------ Number of pits_:'__c_.--' Linmg material------------- Size: Diameter. e ❑ i . ----- f - `- Liquid Capacity----------------------------gals. Cesspool: Distance from nearest well---------------- from foundation__-__-------'----�Lining size: Diameter. = ---� Depth-------------------------- --------- ---�,- ❑ _--__.-__:Distance from nearest building___ ----------- --------------------- Distance from nearest well ------------------------------ -- " Privy: n I _.. ❑ - �..'°rs. -Distance'to-nearest-lot Line------==-----------f,- -:- - -•--- - --------•-- f--y .. ---- Remod ing and/or repairing {descr�be�:_ -- _ • rsl-__(._/ ''_- -__ ._ �_4-> _ ? -� X! nr x /// _ __ ----------------- _ _-, _ I hereby-certify that-I have prepared this application'and that the work will, be done in accordance with San Joaquin County ations of the San Joaquin Local Health District. ordinances, State laws, and rules and regul ------(Owner and/or Contractor --- ------------------ ------------------------ (Si ned - t r; arse side).------- g } ------F s - [Title} By-------------------------------------------------------------------------- --------------------•----------:--- ---- -- _ w is buildings, (Plot plan, showing size of lot,-location`of system in.relat�n to wells, buildings, etc., can be placed on rev # -FOR DEPARTMENT USE ONLY { t I DATE DATE._ APPLICATION ACCEPTED BY----------- ------------=- --------------------- -- ------------------------------------------- -- ----- ---- --------- ---------- -� Wv DATE------------------------------- REVIEWED- 13Y---- --------=----------- ----- ------ ----- -- -- ----- -- ---- - --- -- - --------------- -- ------ -------- BUILDING PERMIT ISSUED -----•----------------------------- -- ------ ------- Alterations and/or recommendations:-_ ___--_.___r-__-- ---- -------------------- ) _ _______________________ ----- ----------------- =------------------- ------------------- -- -------------------- s '' `: E ------------------------ ---------- ------ --------- ---------- FINAL INSPECTION BY� _- ' SAN JQ UIN LOCAL HEALTH DISTRICT 814 North "C' Street 300 West Oak Street 132 Sycamore Street 130 South Amerieen Street Lodi, California Manteca, California Tracy, California Stockton. California \ ES--9-2M Revises 1-57 F.P.CO.