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FOR OFF I CE USE APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby malde to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complian-ce with County Ordinance No. 549. ZOO-0 7 JOB ADDRESS AND LOCATION_ ---------- K �nnor^ .~""�. °``�^�~� �� ~ �6� --^�='--�~��--�'�-sr '-�---''^1�;��---------^-------------''—'—'--'' �o� Contractor's Numo ______._._.________._______________.. _____---------- Installation will serve: Residence R) Apartment Hous" � Comman�| � l�� C�� Wc�| � Other E] Number ufliving units- J-. Number nf6e63 bedrooms __3--- Lo+ , � �e - - "�.�-�- �' --------------------------------- � , Num6o, of6mtks �� � �� ; Public system E] �mmu� o�m [I Private M Depth to ��r �� ^.;�' ft. Character ofsoil toadepth of3feet: Sand E] Gravel E]� Sandy Loam 0 Clay Loam PR Clay [I AdobeFl HardpanJ� ` Previous Application Made: (|f yes,date -------- -------- No New Construction: Yes8�j No F] FHA/VA. Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool po,mifMw6 if public sewer {^ available within 200 feet.) -4 �-' D��tufro foundation-/o----- " Sop6c Tank' Distance from nearest *eU..48 - Wa�^io| -----�-=-^- - � I-j— ..��--------C*po�+y./a�.�� -..No. ofcompo,�nan|o--- .-..--- Size. ----------------------------- iqu �Ak- Di,po'u| Field; Distance from nearest woU4�^-'Distunco from foundation-xA~--�'Distance to nearest lot Ume-'�---.. h of � |i � Widthtrench_ -------------------- ---------- Number ' r~ Type of filter moto,i op+h of �|+or mu+°rivL-.��_--.7vto| |angfh.��.��'-'`---,----.. r � . - - �-° Seepage Pit: Distance to nearest well #1!` fr6m founclation-_1----~---Di,toncuto near line----------------- . M� Number of p�o �� ----..Lining mnte�u| Dinmofec�� .,_--Dep+h-��.--- ---- ' Distance from nearest woU '-'---D�tunce �om fpvn6u�on—'--'��-Uniog matehnL—''-'''--'--'- Cesspool:- Size: Diameter --.------�---�Deofk--- ---'------�----..�quid Cupodt�---------.ga|,. C� -- ° Privy: Distance from nearest well ----------------------------------------- from nearest building . - [ Distance to nearest |o« line--------------- -------------------------- ------------------------ ------------------------------------------------------------------.- RemoJeling and/or n,po�hng (describe):------ ---------------------------------------------------------------------------------- --_-----''-'--'-'--''-- ` ---'---------'---'-'-------'------------''-----------'--------'------------'---- '----------------'----'-'-----------'----''--'--'--'—'------'---'--''---'''-''-'---'-'' --'-'-'----''�-'--''-'''--- ------------------------ ---------------------------------------- / have ned this application and that the work will be done in accordance with San Joaquin County , ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District. � � �� ---------------------------�|gnm6l.---x�� .. ----.� ,~"�. an6/o, Contractor) By. -'-'R�|�^---------------------- -` -------..�.--.-_'----'-'-------------'- --- (Plot ulan. oho*3n'g size of lot location of system in relation to wells, 6uUdings, efc., can he placed on reverse side). � FOR DEPARTMENT USE ONLY ~E,.E,,E" ..-------------------------------- ----------------------- - --------------------- --------------------------------------------- 8U|LD|NG PERMIT ISSUED---------- -------------------------------------------------- ------ ------------------------------- DAT[------------------------------------------------------------- Alterations and/or ._Alto,mGon* un6/or recommendations:----------------- ----------------------------- ----------------------- -------------------------------------------------------------------------------------- ---------'-----------------------------------------'-----------------'-- ----------------I---------------------------- -------------------------------------- ----------------------------------------------------------------------------------- ------------------------------------------- --------- ----------------- -------------------------------------------- '''—'—'''--'''-''''—'---'''--''' ------------- -------------------------------------------------------------- --'----------------------'—.------ --------------------------- --- ---�'''_—'''_-'��''--'--''--'--'''— ----- - -------------------------------- - FINAL INSPECTION -------- --- --- SAN JOAQU\NLOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street n*Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - CS 9 p='.S"" "'= "M 3''AS* ,.P=0.