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-------------------- --------- ------------------Ly ------ - ----------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. 21.2- (Complete-in Duplicate) - ------------ - - -- -•- -- - .1.,�.:. - This Permit Expires 1 Year,f o Date Issued .��Date Issued ' Application is hereby made to the San Jeaquin--Locit- ealth Distr ct f6r4;petmit,to c4nstruct and install the work herein described. This application is made in compliance with County Oridin ante No. 949: OF JOB ADDRESS AND LOCATION....;_. Eh{'_`... '.... . -- ti ..... ar Owner's Name, . .. ....1� _._ .. tip Address Contractor's Name-----• . --- ......... .... .. ' ?...- �.......... _-. - .......................... Phone..,.w��. 00 Installation will serve: Residence Apartment House ❑.:Commercial ❑ Trailer Court '[] Motel Other ❑ Number of living units: ..Z. Number of bedrooms .: : Nunhber of baths ..- Lot size .. _____ ° ...................... Water Supply: Public system ❑ Community system [Private ❑ Depth fo Water Table:. ft Character of soil to a depth,of 3 feet• Sand [j, Gravel El Sandy Loam e0ay Loam ❑ Clay 1771 Adobe❑' Hardpan❑ Previous Application Made: (If yes,date-_._.. --------- ) No [ New Construction: Yes [] No FHA/VA: Yes [ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank_.or mit.cesspool perreitllsd , public s +tw is awala�le within 200 feet.l Septic Tank: Distance from nearest well.... ...........Distance from foundation .................Material ............... _.....-......... ....-:._._..._, ❑ No. of compartments--------------------------Siz*44 .......... •-- •. ----:.Liquid depth-------- ------ --------Capacity..............._......_... Digposal Field: Distance from nearest well-----------------Distance from foundation .................Distance to nearest lot line....... ' Number of lines---- --------- -:---- .--.Length of each line.....................;_........Width of trench Type of filter material...... ___ .Depth of filter material--- Total length........ .... Seepage Pit: Distance to nearest ell.A?Ir °...Distance frim f nation _f-�. .,..D'st ce to nearest lot llne { ❑ llber of pita_ ---- _ Lining n1a#eriaL._.,tf_ r.. ize: Diameter •_Depth....... rt--------------•. _ Cesspool: D1s#arnce"from nearest well ._.........—Distance from foundation .............. ..Lining material..................................... " . Liquid Capacity.. -- ..:gals....: Privy: Distance from nearest well :.._.--- _ ------ --------------------- ____ ___________ _ '_Distance fromniiites d:ar-1.;.m;,� .•-- ❑ Distance to_nearest lot line .= ----- -------------------------------------------------------------....... Remodeling •---- •-•------- -- ---------•- Remodeling and/or repairing (describe) y + r •--- ,. 01 ....,... ........ ............. ..... ... ................................. ......._ ........ ...---------............................................ hereby certify,:that I have prepared this application and that the work will be done in accordance with'Satt.Joaquin County, . ordinances, State laws, and rules and regulations of the San Joaquin Loc I , th District. 11 Nl �.` .. . (Signed)............._. . . . . ..:.: nor and/or-Contractor) By ------ + ., ......� z --- ---•-- - --(rifle) 4... --- ------ ------ (Plot plan, showing size of lot, location of,syst , in'relation#o wells, buildings, etc-, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..:�._.. -' --------------------------------------------------------------- ...... DATE.. .................... -•---- REVIEWED BY.............................. . - -. 4-Z DATE ' VILDING,,RERMIT ISSUED---- ----• ................ DAT ............................................. Alterations and/or recommendations:------ --- __. . --....--•. . .. .........•---- . ----• ---•-.._ ..... ..... ..... - -- -. -•--- -- ------- ------ ----------------- ...............--- .--- -•------ -•---•-• . _: .. .--....................... ......... .•...--•---..--•- - -- - •- 4 FINAL INSPECTION BY ------- - VANOAQQUIN ----; Date............ '- f�q- ------------------------ LOCAL HEALTH DISTRICT 1601 E.Ha:elten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9tb Sheet Stockton,California Lodi.Californici_, Manteca,California Tracy,California 4 E.H.9 2M 1-67 Vanguard Press a %