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• r i 1l,L VJc: t - ..-.-------- ------ - - --- "--- --=-�-------- --- ------ ---p�7��c�--- . APPLICATION FO '�� / _ R;SANITATION PERMIT Per4lit,.Na. fo � - (Complete•in Duplicate) This Permit tx fres 2 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install Date Issued ..�":��"._�� the work herein described. This application is made in compliance with County Ordin nce N 9. JOeADDRESS A ATION � Owner's Na "•" � - ----- ----- -" -�- _ --------- -- Address --------- ---'------. Phone- _ � Contractor's Installation will serve: R sidence Phon _ Apartment House o erclal - ---• Number of living units: Number of bedrooms . _ �J Trailer Court ❑ Motel ❑ Other [] " umber of baths Water Supply: Public system --._ Lot size Y ❑ Communitysystem ------------------- Y ❑ Private Depth to Water Table 7-s_ft Character of soil to a depth of 3 feet• Sand 4 ❑ Gravel ❑ Sandy Loam 0 ClayLoam Previous Application Made: (If yes,date----_----"--_ ❑ Clay El Adobe Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS: , No New Construction: Yes ❑ No { ,�—FHA/VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ' Septic Tank; p Distance from nearest well-Distance from f undation__ No. of compartments__._ 7,"• ---- Material - --- ----- -r- Size_-'gI?d E Liquid depth_ S ![- Capacity e Disposal Field: Distance from nearest weff.--(gs"-.__Distance from foundation_. "_.- Number of fines.__ Distance to nearest lot line___..- "•. Length of each line_'__`--- i' Width of trench_-" !C Type of filter material__- Depth of filter material_-__. �'---------------- Seepage Pit: Distance to nearest well, /10 ---------Distance om f undation_ Notal length-------- •�L ._-_.Distance to nearest fot fine__. Number of pits�l(„t._�,I) Lining material"_ t/ �----_---. � Cesspool: -- Size: Diameter3_ - ---------Depth--�� ❑P Distance from nearest well +Distance from foundation------------- _Lining material__.___-_--.-"-". Size: Diameter_ "- -_."---_ " - ..........Depth--------- ----- -- ........... ............. - -- ------ ....... '---- Liquid Capacity---------------- --- Privy: Distance from nearest well--------------_ g is. Distance from nearest building ------- Distance to nearest lot fine. gRe del�g a or. repairing (describe):_-- -- - lbl� ai __ __..__ ___ __._422 _____________ _--._ __--__ - .___--.__ __________________________________ _"___._.____—___-__-__-___ __,_ _ _ _-._ _.___ _ -------------- ---------- - ------------- --'--- 'r-L..J I hereby certif at a prepared this application and at the work will be done in accordance with San Joaquin Count ------------------------------------ _ ___ ___ or lnances, State aws, and rul and r Iations of the San oaquin Local Health District. County (Signed) - -- ---•------------ ---Son - ne Ow, rand/or Contractor), (Plot plan, showing six ot, iocationtem in rely}into wells, buildings,•etc., can(bele)""-pia reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I3Y.___._ -----' --- DATE REVIEWED BY s UILDING PERMIT ISSUED-------- -- ------- - ----- -------------- --- ---- DATE---------- -- ' Alterations and/or recommendations:.._-_"--_- ------------------------------------------ DATE----------- --------------------- � ! ------------- -------------------------- -------- - ///{�J//�/J //%yam/• _______________________________ ___________________ ____ ____ `�iFJ✓. - f _______________ FINAL INSPECTION BY:... ........ Date �'3C�---------7-------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 160! E.Na:eiton Ave. 300 West Oak Street i24 Sycamore Street Stockton,Caiilorrtie Lodi. California 205 West 91h Street E.H.9 2M 1-67 Vanguard Press Manteca,California Tracy,California b _ � .e